Medical Social Worker (MSW) - Home Care

Granite VNA, Inc.•Wolfeboro, NH

About The Position

At Granite VNA, New Hampshire’s largest home health and hospice provider, we believe in care that helps our patients return to living the life they desire. The care we provide is personal and meaningful. Join our mission-driven team as a Medical Social Worker (MSW) and deliver high-quality support to patients and families by helping them navigate the emotional, social, and practical challenges that come with illness, recovery, or end-of-life care. At Granite VNA, we bring care home – and bring out the best in our team. If you’re ready to trade the in-patient setting for a career with freedom, flexibility and deep impact, we’d love to meet you! Apply today and bring your care to where it matters most – home. Why Choose Granite VNA: A supportive leadership team who leads with compassion and integrity Autonomy and purpose Collaboration with a team full of dedicated, knowledgeable and supportive professionals Competitive pay, mileage reimbursement and generous benefits Ongoing professional development and opportunities for career growth At Granite VNA, we care for our team the same way we care for our patients—by creating a safe, respectful, and supportive environment. That’s why we offer AVADE Training for field staff and Armed Intruder Training for team members in other roles. Clothing stipend for Granite VNA–embroidered apparel so you can proudly represent our organization in the community. Oh, and did we mention lakeside sunsets and fresh air? Position Overview Reporting to the Director, the Granite VNA Medical Social Worker (MSW) provides age appropriate support, education and counseling to the patient and family members in the home setting utilizing standard social work practice. MSWs will effectively interact with patients, care givers and other healthcare team members while maintain all standards of professional practice.

Requirements

Master's degree in social work from an accredited program (Council on Social Work Education)
One year of social work experience in a healthcare setting

Responsibilities

Develops and implements appropriate plan of care (POC) that complies with referral source orders, specific treatment measures, frequency/expected duration and discharge goals in partnership with the patient, healthcare provider, patient representative (if any) and/or caregiver(s) based on thorough assessment incorporating all aspects of patient limitations and goals, and potential discharge environment. Role includes assessment, planning and implementation of behavioral health interventions for that patient population.
Upon request from clinicians and/or referral sources, MSW will offer Hospice Information visits to Home Care patients, provide information about the hospice program and benefits, gather information about the patient’s condition and communicate pertinent information to the Hospice Medical Director to determine the patient’s eligibility for the hospice program.
Documents accurate and ongoing assessment, treatment and discharge of the patient: interventions, patient response to care provided, patient needs, problems, capabilities, limitations and progress toward goals. Documentation includes evidence of appropriate patient/caregiver teaching, and the understanding of these instructions in accordance with agency timeframes.
Engages the patient /caregiver in meaningful education as indicated per care plan.
Communicates with all physicians involved in the POC and other health practitioners related to the current POC.
Demonstrates responsibility to effectively coordinate the patient’s POC with members of the interdisciplinary team and other health professionals through team/patient care conference. Updates patient’s short-term/long-term goals as appropriate based on interdisciplinary team assessments and re-assessments.
Participates in interdisciplinary team, agency projects, committees, QAPI program and/or other activities upon request and approval from direct supervisor.
Attends Agency In-service programs.
Coaches, mentors and precepts new Medical Social Work employees and students.