Home Care Social Worker (MSW / LMSW)

Hartford HealthCare at Home•East Hartford, CT

17h•Onsite

About The Position

Hartford HealthCare at Home, the largest provider of homecare services in Connecticut, is seeking a Home Care Social Worker (MSW/LMSW). This role involves working with patients in their homes to assess their needs and provide short-term interventions to help them achieve their healthcare goals. The position requires collaboration with patients, families, physicians, and the home care team to address biopsychosocial needs and barriers to care. The ideal candidate will have experience with complex healthcare and psychosocial needs, possess strong critical thinking and clinical judgment skills, and be able to respond effectively to crisis situations. Hartford HealthCare at Home utilizes cutting-edge technology and a Person-Centered Care Model, offering opportunities for professional growth and development within Connecticut's most comprehensive healthcare network.

Requirements

Master's Degree in Social Work.
1-2 years of clinical experience required.
LMSW or LCSW required.
Licensure required within one year of hire.
Considerable knowledge of social, cultural, economic, political, religious, medical, psychological, and legal issues that influence the behaviors of patients and families.
Familiarity with evidence-based assessment tools, including: PHQ-9 / PHQ-2, SLUMS, BIMS, FAST, C-SSRS, Caregiver Strain Index.
Knowledge of and ability to obtain community resources, including town, state, and federal programs and eligibility requirements.
Proven ability to work effectively both independently and as part of a team.
Ability to adapt to ambiguity and changing processes.
Excellent written and verbal communication skills.
Strong organizational skills and attention to detail.
Strong computer proficiency, including Microsoft Office.

Nice To Haves

Experience in a healthcare setting is strongly preferred.
Bilingual English/Spanish preferred.
Epic experience is a plus.

Responsibilities

Completes comprehensive in-home psychosocial evaluations, considering developmental, social, cultural, substance abuse, psychological, environmental, and medical factors.
Assesses physical, social, emotional, and family characteristics.
Uses evidence-based assessment tools to determine cognitive status and behavioral health needs, including dementia, depression, anxiety, and related conditions.
Evaluates home safety, family dynamics, caregiver strain, and other risk factors, including suicide risk and access to basic needs.
Assesses the patient and family's understanding of disease processes and treatment options.
Identifies strengths, available supports, and barriers to care.
Determines the appropriate level of care, including long- and short-term skilled nursing facilities, assisted living facilities, adult day care programs, and other services.
Collaborates with the interdisciplinary team regarding patients identified for Social Work Services and assists in identifying additional patients who may benefit from social work support.
Develops a care plan with measurable goals in collaboration with patients and families, based on a comprehensive, culturally competent assessment.
Implements short-term interventions to address identified barriers and promote health and well-being.
Provides clinical treatment services including triage, crisis intervention, individual and family therapy, screening, and care planning.
Utilizes Motivational Interviewing and coaching techniques to assist patients and families in identifying and achieving goals.
Encourages self-determination and independence by building upon identified strengths.
Serves as an educator for patients, families, the community, and other professionals regarding disease prevention, disease progression, the impact of illness, health maintenance, adherence to treatment regimens, and accessing community resources.
Advocates for the needs and interests of patients to improve access to care and enhance service delivery.
Provides patients and families with resources to support discharge planning and transitions of care.
Maintains timely documentation of social work services that accurately reflects assessment findings, treatment interventions, patient and family needs, social work involvement, and outcomes.
Works collaboratively with primary care and specialty physicians, as well as other members of the healthcare team, to improve quality of life and support patients' goals of care.
Functions as an integral member of the multidisciplinary team.
Participates in case conferences and interdisciplinary team (IDT) meetings.
Assists the healthcare team in understanding social and psychological factors related to patient care.
Acts as a consultant to Agency staff regarding abuse, neglect, exploitation, and community resources.
Identifies Hartford HealthCare at Home and community-based resources appropriate for patients and families.
Performs other duties as assigned.