Master Social Worker - MSW

Fresenius Medical Care•Davison, MI

12d

About The Position

This entry-level Master Social Worker (MSW) provides psychosocial services to in-center and, where applicable, home dialysis patients. The role uses social work theory and accepted practice methods to support patient adjustment, rehabilitation, treatment outcomes, and quality of life. Working with the interdisciplinary health care team, the social worker helps staff understand the emotional, psychological, and behavioral effects of chronic kidney disease on patients and families. The role also supports Fresenius Kidney Care quality goals, patient satisfaction, quality-of-life measures, and process improvement activities. The social worker assesses psychosocial needs and strengths, participates in care planning, provides counseling and education within the scope of clinical training and state licensure, and connects patients with community resources. The position supports patients through dialysis adjustment, transplant-related processes, advance-care planning, admission and continuity-of-care needs, and insurance or financial-assistance questions. It also contributes to quality reviews, staff education, team huddles, and maintenance of patient resource information. Travel may be required for multiple facilities or home visits, where applicable.

Requirements

Master’s degree in Social Work.
State-required license.
Must meet 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.
Collaborate with patients and the interdisciplinary health care team on care plans and interventions to support rehabilitation, treatment goals, and quality of life.
Use patient education programs, social work methods, focused interventions, and quality-of-life measurement instruments in assessment and care planning.
Monitor patients’ adjustment to dialysis and provide interventions to support psychosocial status and quality of life.
Provide supportive counseling within the scope of clinical training and state license, and provide educational, goal-directed counseling to patients seeking transplant.
Inform patients and the care team about community resources and assist with referrals, including home health and vocational or educational rehabilitation services.
Maintain knowledge of local vocational and educational rehabilitation programs and help patients access them.
Assess patient awareness of advance directives, provide access to forms and information, and facilitate discussions with the health care team and family or support persons as needed.
Participate with the physician and nurse in discussions of patient DNR status to support informed decisions by patients and/or families.
Follow applicable social work and patient-function measurement policies and document interactions and interventions.
Provide psychosocial support and social work interventions addressing non-adherence, quality outcomes, and quality-of-life concerns.
Participate in monthly interdisciplinary quality reviews and report on adherence indicators, quality-of-life trends, and service recovery.
Assess patient knowledge of kidney disease and barriers to treatment adherence; coordinate tailored education with patients, families, and the care team.
Provide information about treatment modalities and support the transplant referral process and 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.
Review required admission materials and address immediate patient needs or concerns.
Support referral and admission processes, including scheduling needs that may affect adherence and adjustment.
Interview patients requesting discharge to identify the reasons and share relevant concerns with operational leadership.
Liaise with Insurance Coordinators regarding patient insurance issues and educate patients about dialysis payment sources and assistance programs.
Coordinate with Insurance Coordinators when patient status changes may affect insurance coverage; refer treatment-bill questions to Patient Billing Solutions.
Assist with interviews and hiring decisions for new personnel when requested by the SW Manager or Senior Manager.
Work with administrative support staff to keep patient resource lists current.
Provide staff training on psychosocial topics as needed and participate in weekly team huddles, raising urgent patient issues.
Follow caseload guidelines based on state regulatory requirements.
Perform other related duties as assigned.