Master Social Worker - MSW

Fresenius Medical Care•Flint, MI

10d

About The Position

The Master Social Worker provides psychosocial services to patients receiving in-center and, where applicable, home dialysis. Using social work theory and accepted practice methods, the role works with the healthcare team to promote patient adjustment, rehabilitation, and quality of life. The social worker helps staff understand the emotional, psychological, and behavioral effects of chronic kidney disease on patients and families, and supports quality indicators, quality assessment and improvement activities, patient satisfaction, and quality-of-life outcomes. This is an entry-level MSW role. The position assesses patients’ psychosocial needs and strengths, participates in care planning, provides supportive and goal-directed counseling within the scope of clinical training and state licensure, and connects patients with community and rehabilitation resources. It also supports patient education, transplant referral and waitlist processes, advance-care planning, continuity of care, and insurance and financial assistance navigation. The social worker collaborates with the interdisciplinary team, participates in quality reviews and team huddles, and provides staff training on psychosocial topics as needed.

Requirements

Master’s degree in Social Work.
State-required license.
Meet the applicable scope-of-practice board and licensure requirements in the state of employment.
0–2 years of related experience.

Responsibilities

Assess patients’ psychosocial status, strengths, and needs that may affect rehabilitation and treatment outcomes as part of the comprehensive patient assessment.
Collaborate with patients and the healthcare team on care planning and interventions that support rehabilitation, treatment goals, and quality of life.
Use patient education programs, social work methods and interventions, and quality-of-life measurement instruments in assessment and care planning.
Monitor patients and provide interventions to support adjustment to dialysis and optimal psychosocial status and quality of life.
Provide supportive counseling within the scope of clinical training and state licensure, and provide educational and goal-directed counseling to patients seeking transplant.
Refer patients to community resources, including home health services and vocational rehabilitation, and assist with access to vocational and educational rehabilitation programs.
Assess patient awareness of advance directives and assist with information, forms, and discussions with the healthcare team and family or support persons.
Participate with the physician and nurse in discussions of patient DNR status to support informed decisions.
Follow applicable social work and patient-function policies, including documentation requirements, and document interactions and interventions with patients and families.
Provide psychosocial support and social work interventions for non-adherence, quality outcomes, and quality-of-life concerns according to patient acuity.
Participate in monthly interdisciplinary quality reviews and report on indicators including missed or shortened treatments, quality-of-life trends, and service recovery.
Assess patients’ kidney-disease knowledge and barriers to treatment adherence; tailor education to patients’ learning styles, communication barriers, and needs.
Provide information about treatment modalities with the interdisciplinary team, facilitate transplant referrals, and collaborate on transplant waitlist management.
Educate patients and families about psychosocial issues related to ESRD and available support services.
Review patient rights and responsibilities, grievance information, and facility policies with patients or their representatives.
Collaborate with the team on quality assessment and improvement activities.
During admission, review patient rights, grievance procedures, important contact information, the non-discrimination policy, and applicable DNR information, and address immediate needs or concerns.
Support referral and admission processes and scheduling to promote treatment adherence and adjustment.
Interview patients requesting discharge to identify concerns or reasons, such as hospice transfer, relocation, or dissatisfaction, and share them with operational leadership.
Liaise with insurance coordinators to address patient insurance issues and educate patients about dialysis payment sources and assistance programs.
Notify insurance coordinators of patient-status changes that may affect coverage, including transplantation, discharge, loss of coverage, or extended travel.
Refer treatment-billing questions and concerns to the patient billing solutions department.
Assist with interviews and hiring decisions for new personnel when requested by the Social Work Manager or Senior Manager.
Work with administrative support staff to maintain current patient resource lists, such as transportation resources.
Provide staff training on psychosocial topics as needed and participate in weekly team huddles, raising urgent patient issues with staff.
Follow caseload guidelines based on state regulatory requirements and perform other related duties as assigned.