Master Social Worker

Fresenius Medical Care•Apopka, FL

About The Position

Provides psychosocial services to in-center and, where applicable, home dialysis patients using social work theory and accepted practice methods. Works with the healthcare team to support patients’ adjustment, rehabilitation, treatment outcomes, and quality of life. Educates and supports staff in understanding the emotional, psychological, and behavioral effects of chronic kidney disease on patients and families, and participates in quality indicators, quality assessment and improvement activities, and process improvement. The role includes psychosocial assessment, care planning, counseling, patient education, referrals to community and rehabilitation resources, advance directive discussions, support with transplant processes, and assistance with patient admission and continuity of care. The Social Worker also supports patients with insurance and financial-assistance questions, contributes to quality reviews and team activities, and provides staff training on psychosocial topics as needed. The role has no supervisory responsibilities. Travel may be required if the position covers multiple facilities.

Requirements

Master’s degree in Social Work.
State-required social work license.
2–5 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 healthcare team on care plans and interventions to support treatment goals and quality of life.
Use patient education programs, social work methods, interventions, and quality-of-life measurement tools in assessments and care planning.
Monitor patients’ adjustment to dialysis and provide supportive counseling within the scope of clinical training and state licensure.
Provide goal-directed counseling and education to patients seeking transplant, facilitate transplant referrals, and collaborate on transplant waitlist management.
Refer patients to community resources, including home health and vocational or educational rehabilitation programs.
Assess patients’ awareness of advance directives and assist with information, forms, and discussions with the care team and family or support persons.
Participate with physicians and nurses in discussions of patient DNR status to support informed decisions.
Document social work interactions and interventions and adhere to applicable social work and patient-function policies.
Provide psychosocial support and focused interventions related to non-adherence, quality outcomes, and quality-of-life concerns.
Attend monthly interdisciplinary quality review meetings and report on indicators such as missed or shortened treatments, quality-of-life trends, and service recovery.
Assess patients’ kidney disease knowledge and barriers to treatment adherence, and tailor education to patients’ learning styles and communication needs.
Provide information about treatment modalities, ESRD-related psychosocial issues, and available support services.
Review patient rights, responsibilities, grievance information, and facility policies with patients or their representatives.
Support patient admission and continuity of care by reviewing required information, identifying immediate needs, and assisting with scheduling to support adherence and adjustment.
Interview patients requesting discharge to identify concerns and share them with operational leadership.
Liaise with insurance coordinators regarding insurance issues and educate patients about dialysis payment sources and assistance programs.
Notify the Insurance Coordinator of patient status changes that may affect insurance and refer billing questions to the patient billing solutions department.
Assist with personnel interviews and hiring decisions if requested by the Social Work Manager or Senior Manager.
Work with administrative support staff to maintain current patient resource lists.
Train staff on psychosocial topics as needed, participate in weekly team huddles, and discuss urgent patient issues with staff.
Follow caseload guidelines based on state regulatory requirements and perform other related duties as assigned.