SOCIAL WORKER (MSW) - CASE MANAGEMENT

Beebe Healthcare•Lewes, DE

44d

About The Position

The purpose of the Social Work job is to provide professional social work services to patients and their families as a vital part of the interdisciplinary healthcare team by: Assessing patient's psycho-social needs and social determinants of care with emphasis on resource deficits, crisis intervention and discharge/transition of care requirements with an emphasis on complex and high-risk patients. Coordinating provision of external or internal medical or social services based on the plan of care including but not limited to community resources, home care, DME, acute rehab, hospice services or skilled nursing facility. Contributing to the plan of care by introducing relevant psychosocial concepts and patient specific information. Providing clinical or therapeutic interventions, assessing, and managing cases of suspected abuse, and advocating for patient rights (e.g., advance directives).

Requirements

2 years clinical social work healthcare experience, preferable med-surg hospital experience
Experience with PC, mainframe, or Internet based information systems.
Knowledge and experience with Electronic Health Records, Cerner and Curaspan preferred.
MSW is required.
Complete Case Management Certification within 3 years of hire
Clear Communication Skills Both Written And Verbal
Able To Keep Confidential Information Regarding Patients, Team Members
Able To Withstand Crisis Situations
Has Skills To Provides Customer Service To Patients, Team Members And Visitors
Knowledge And Experience With Electronic Health Records

Nice To Haves

Knowledge and experience with Electronic Health Records, Cerner and Curaspan preferred.

Responsibilities

Performs psychosocial assessments with patient and family that are consistent with age and developmental status (per department standard).
Works with others to ensure a valid patient Advanced Directive is completed and documented.
Works with uncooperative or challenging patients/family members in to gain cooperation regarding treatment and discharge goals.
Reviews information about patient's proposed living arrangements and evaluates security, hazards, and resources to assess the suitability of the living conditions upon discharge.
Prepares patients for discharge or movement from one living arrangement to another.
Performs discharge planning activities that are age specific and designed to best meet the patient's aftercare needs and involves patients/families as much as possible in the planning.
Informs the physician, nurse, and other members of the health care team as appropriate regarding the discharge plan.
Educates patients and their families regarding resources in the community that can assist in maintaining patient health status and in addressing on-going psychological issues.
Develops appropriate plan of social work interventions based on issues/problems identified through the psychosocial assessment.
Coordinates medical, social, or financial support services to ensure efficient and effective process of care.
Contacts agencies by letters, memos, e-mail, or phone to refer patients/families to services.
Communicates with health care team members regarding issues that may impact an efficient process of care or desired clinical outcome.
Communicates the patient's progress and ongoing care needs to post-discharge caregivers.
Assists patients/caregivers with follow-up appointments and what to do if medical attention is needed prior to that time.
Uses resources effectively to ensure timely discharge of patients to the appropriate level of care.
Other duties as assigned.