Master Social Worker

Fresenius Medical Care•Apopka, FL

About The Position

Provides psychosocial services to in-center and home dialysis patients, applying social work theory and accepted practice methods. Works with the healthcare team to promote patients’ adjustment, rehabilitation, and quality of life, and helps staff understand the emotional, psychological, and behavioral effects of chronic kidney disease on patients and families. Supports quality indicators, patient satisfaction, quality-of-life outcomes, and process improvement activities. The role assesses patients’ psychosocial needs and strengths, contributes to collaborative care planning, provides counseling and education within the scope of clinical training and state licensure, and connects patients with community resources. It also supports patient education, transplant referrals, continuity of care, advance-care planning discussions, insurance and financial assistance coordination, and facility quality activities. The position has no supervisory responsibilities and may require travel when covering multiple facilities.

Requirements

Master’s degree in Social Work.
State-required 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 healthcare team on care planning and interventions to support 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 licensure, and goal-directed counseling for patients seeking transplant.
Refer patients to community resources, including home health services and vocational rehabilitation.
Maintain knowledge of local vocational and educational rehabilitation programs and help patients access them.
Assess awareness of advance directives and help patients access information and discuss their wishes with the care 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 physical and mental function policies, including documentation requirements.
Document interactions and interventions provided to patients and families.
Provide psychosocial support and focused interventions related to adherence, quality outcomes, and quality-of-life concerns.
Participate in monthly interdisciplinary quality review meetings and report on adherence indicators, quality-of-life trends, and service recovery.
Assess patients’ kidney disease knowledge and barriers to adherence, and tailor education to learning style, 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.
Review admission-related materials and address patients’ immediate needs or concerns.
Support referral and admission processes, including scheduling needs that promote adherence and adjustment.
Interview patients requesting discharge to identify underlying concerns and share them with operational leadership.
Liaise with insurance coordinators to address patient insurance issues and provide information about dialysis payment and assistance programs.
Notify insurance coordinators of patient status changes that may affect coverage.
Refer patients to the patient billing solutions department with treatment-bill questions or concerns.
Assist with personnel interviews and hiring decisions when requested by the social work manager or senior manager.
Work with administrative support staff to maintain current patient resource lists.
Provide staff training 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.
Perform other related duties as assigned.