The Social Worker serves as a patient advocate and care-management partner, assessing and addressing patients’ psychosocial needs and supporting discharge planning for complex medical conditions. The role collaborates with patients, families, and the interdisciplinary team to identify barriers to care, provide interventions and counseling, connect people with resources, and support the best possible outcomes, particularly for chronically ill patients and those receiving end-of-life care. The position includes assessing psychosocial needs through interviews, team consultation, and medical-record review; evaluating coping, functioning, support, and resources; communicating and documenting assessments and plans; providing crisis intervention and supportive counseling; responding to suspected abuse or neglect; and making referrals to community services. The Social Worker also supports family decision-making and meetings, coordinates with agencies, reviews complex cases with a manager, evaluates financial assistance needs, maintains knowledge of post-hospital reimbursement and community resources, and educates patients and families about rights and advance directives.
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Job Type
Full-time