Prelicensed Social Worker

Fresenius Medical Care•Astoria, OR

About The Position

Provides psychosocial services to in-center and home dialysis patients, as applicable, using social work theory and accepted methods of practice. Works with the healthcare team to promote patients’ positive 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, quality assessment and improvement activities, patient satisfaction, and process improvement. This is an entry-level MSW role. The Social Worker assesses psychosocial status, strengths, and needs; collaborates on care planning; provides counseling and education within the scope of clinical training and state licensure; connects patients with community and vocational resources; and supports discussions about advance directives and DNR status. The role includes documentation, quality monitoring, patient education, admission and continuity-of-care support, assistance with insurance and financial resources, and collaboration with clinic staff. The position has no supervisory responsibilities. Travel may be required when supporting multiple facilities.

Requirements

Master of Social Work (MSW).
Must hold a state temporary license, Registered Social Worker Clinical Intern credential, Associated Social Work license, or Provisional LCSW license, if required by the state.
Obtain the state licensure required to work independently without supervision within the first two years or as required by state guidelines.
0–2 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, interventions, and quality-of-life measurement instruments to address barriers to treatment goals.
Monitor and support patients’ adjustment to dialysis and psychosocial status.
Provide supportive counseling within the scope of clinical training and state licensure, and goal-directed education and counseling for patients seeking transplant.
Connect patients with community resources, including home health services and vocational rehabilitation, and assist with referral and access to vocational and educational rehabilitation programs.
Assess patients’ awareness of advance directives and assist with forms, information, and discussions 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 FMCNA social work and patient physical and mental function policies, including documentation of interactions and interventions.
Provide psychosocial support and social-work-focused interventions addressing non-adherence, quality outcomes, and quality-of-life concerns according to patient acuity.
Participate in monthly interdisciplinary quality review meetings and report on indicators such as missed or shortened treatments, quality-of-life trends, and service recovery.
Assess patient knowledge of kidney disease and barriers to treatment adherence; tailor education to patients’ learning styles, communication barriers, and needs.
Provide information about treatment modalities, facilitate transplant referrals, and collaborate on transplant waitlist management.
Educate patients and families on 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 rights, grievance procedures, non-discrimination policy, DNR information when applicable, and immediate patient needs or concerns.
Support the referral and admission process, including scheduling considerations that promote adherence and adjustment.
Interview patients requesting discharge to identify concerns or causes and share them with operational leadership.
Liaise with Insurance Coordinators to address insurance issues and educate patients about payment sources and assistance programs for dialysis.
Inform Insurance Coordinators of patient status changes that may affect insurance, and refer billing questions or concerns to the patient billing solutions department.
Assist with personnel interviews and hiring decisions if requested by the Social Work Manager or Senior Manager.
Maintain updated patient resource lists with administrative support staff.
Provide staff training on psychosocial topics as needed, participate in weekly team huddles, and discuss urgent patient issues with staff.
Adhere to caseload guidelines based on state regulatory requirements and work under appropriate supervision where required.
Perform other related duties as assigned.