The Medical Social Worker provides social work services to patients, families, and individuals. This includes psychosocial assessment, screening, determination of needs evaluation, appropriate interventions and follow up, and discharge planning. The role involves implementing interventions substantiated by assessment as appropriate to the needs of the patient/client system and consistent with available resources and payer network. The Medical Social Worker participates as part of the multi-disciplinary health care team to develop safe and timely coordination of care, including post-acute placement, palliative/hospice service lines, medical equipment, home healthcare, outpatient follow up, mental health resources, and other community resources. They advocate for patient involvement in the plan of care and coordinate interventions with other members of the health care team. The role requires staying knowledgeable in healthcare regulations, reimbursement issues, impact on length of stay, and community resources. Additionally, the Medical Social Worker completes Utilization Management (UM) activities, delivers CMS regulatory notices, and communicates effectively with the healthcare team, working in partnership with RN Care Managers and unlicensed support personnel. They serve as an active member of the MDR, collaborating with medical staff, hospital departments, and ancillary services to resolve barriers to discharge and expedite care delivery. The position also involves providing resources and education to patients and families regarding community resources, legislation, and regulations, and connecting patients to appropriate agencies for issues of suspected abuse and neglect, domestic violence, guardianship, and other social matters. Support and connection to additional services such as bereavement and loss, ethical issues, advanced directives, and end-of-life issues are also provided. The Medical Social Worker collaborates with community agencies and institutions to plan continued care and coordinate interventions, documenting activity according to department and program protocols. They manage the progression of patient stays to optimize length of stay (LOS) and ensure appropriateness of assigned Level of Care, and manage patient care across the continuum to decrease unnecessary readmissions and coordinate care within an ACO environment. Participation in the orientation of new staff and/or education of social work students is expected. The role also includes providing education to patients/families regarding Advance Directives and assisting with their execution, and participating in legal proceedings as necessary. The Medical Social Worker maintains professional standards and completes required continuing education to maintain licensure and knowledge within their specialty.
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Job Type
Part-time
Career Level
Mid Level