The Medical Social Worker reports to the Clinical Manager and participates in interdisciplinary care for home health patients. The role evaluates each patient’s emotional and social needs and develops a personalized plan of care. When a Social Worker Assistant is involved in a patient’s plan, the Medical Social Worker provides direction and supervision. The position operates in accordance with CenterWell Home Health policies and procedures, applicable healthcare standards, and governmental laws and regulations. The Medical Social Worker assesses patients’ social and emotional circumstances in relation to their illness or injury, care needs, treatment response, and adjustments to care. They evaluate the relationship between medical and nursing needs in the home setting, financial resources, and community resources, and take appropriate action to connect patients with available community support. The role also maintains ongoing communication and assessment with patients, families, and organizational associates, and participates in interdisciplinary care coordination. The position includes evaluating the Social Work Assistant’s performance and maintaining and submitting required documentation, including case conferences, patient and physician community contacts, visit reports, and progress notes. The Medical Social Worker confers with other healthcare disciplines to support optimum patient care. This is a per-diem, patient-facing role requiring local travel and compliance with Humana’s TB screening and driver safety programs.
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