MSW-Social Worker

WellBe Senior Medical - Mercer, PA

Full-time - Entry Level

Mercer, PA

Social Assistance

About the position

Our MSWs are part of a team that provides compassionate care to the frailest elderly who have chronic and acute illnesses or injuries living in their homes. Our MSW delivers primary, urgent and acute care and counseling to a wide variety of patients with social and behavioral problems. The MSW will be accountable for caring for patients, connecting patients and their families to support services, maintaining accurate and current patient records and scheduling and administering initial, urgent, and follow-up appointments to patients as required. The successful candidate will work as a team with our physicians, advanced practice clinicians, and care team coordinator will assist in delivering quality care to every patient. We offer a positive, upbeat work environment where all medical personnel work together for the good of the patient.

Responsibilities

• Practices the WellBe mission: To help our patients lead healthier, meaningful lives by delivering the most Complete Care.
• Telephonic outreach to patients and providers requesting assistance with community resources and social determinant of health needs.
• Develop plan of care responding to patient requests and assessment outcomes.
• Provide community resource coordination for patient requests and psychosocial problems.
• Collaborate efforts with multidisciplinary team to identify and respond to patient psychosocial needs.
• Develop and organize WellBe community resource directory.
• Utilize internally approved computer systems to identify internal and external resources.
• Document assessment and patient encounters following WellBe standards and best practices.
• Build rapport with patients and their families and relay all concerns to WellBe provider/IDT.
• Coordinate with other healthcare providers, agencies and community resources in order to create a thorough treatment plan addressing social, cultural, and financial needs.
• Collaborate with the interdisciplinary team and participate in regularly scheduled team meetings.
• Ensure compliance with regulatory agencies and WellBe clinical guidelines.
• Partner with community team to refer patients to appropriate no or low-cost community services that support health and independence such as Meals On Wheels (MOW), local Area Agencies on Aging (AAA), Senior & Assistance Programs, and transportation resources.
• Involve the patients' families and primary caregiver(s) as needed to achieve the best care decisions and outcomes.
• Effectively collaborate with all those involved in the members' care, including health services contractors (i.e., Home Health, Hospice, Community Agencies), to meet the patients' care goals.
• Comply with safety policies and procedures, identifying and immediately reporting any potential or actual unsafe acts or conditions to their supervisor/team.
• Consistently meet or exceed WellBe targets for productivity, customer service, quality assessment, and performance targets.
• Understand the importance of community involvement and participate as appropriate in activities that link WellBe to its communities.
• Maintain current written progress notes and other documentation on the member Medical Record including signed and dated documentation for all service performed the day the service is provided.
• Participate in program and policy development of the WellBe Social Work program.
• Other tasks needed to accomplish team's objectives/goals.

Requirements

• Master's Degree in Social Work
• Two years social work experience, preferably in health care, and minimum one-year experience working with a frail/elderly population.
• LSW required
• Age specific competency in working with the elderly and knowledge of community services for the elderly and their families.
• Ability to make psychosocial assessments and develop and implement viable care plans.
• Must be familiar with EHR medical documentation.
• Strong computer skills, including Word, Excel, and Powerpoint.
• Strong verbal, written, presentation, and interpersonal communication skills.
• Bilingual in English/Spanish preferred.
• Ability to work effectively in a team environment.
• Knowledge of social work principles and practices, including case management and counseling techniques.
• Ability to empathize with clients.
• Ability to provide after-hours services as needed.
• Ability to leverage internal and external resources as part of a patient's treatment plan.
• Experience writing assessments and reports to monitor client progress.
• Valid driver's license, have access to a car and willingness to drive to patient homes/patient location as well as an active auto insurance policy.

Benefits

• Rich and competitive total rewards package including health benefits, dental, vision, life insurance, dependent care reimbursement, STD/LTD, 401k match with immediate vesting, paid time off / floating holidays, commuter/transportation (mileage) reimbursement, and educational reimbursement.