Social Worker - Groves

Carolina Meadows Careers•Chapel Hill, NC

23d•Onsite

About The Position

Carolina Meadows, a continuing-care retirement community in Chapel Hill, North Carolina, is seeking an experienced Social Worker with a strong interest in working with older adults. This role focuses on care coordination and psychosocial support for residents in the Health Center. The Social Worker will act as an advocate, resource, educator, facilitator, counselor, historian, and organizer for residents and their families, evaluating their mental, emotional, and psychosocial needs in relation to their overall health and wellbeing. The position aims to promote resident dignity and optimal benefit within the long-term care continuum through solution-focused supports and care coordination.

Requirements

Master’s Degree in Social Work or an equivalent degree in a related field (Bachelor’s of Social Work degree considered with strong experience).
Minimum of two years’ experience working in a long-term care or health care setting with care coordination or case management services.
Interest and ability to work with older adults in a Continuing Care Retirement Community.
Aptitude to effectively collaborate with an Interdisciplinary Team of professionals.
Ability to work in a fluid environment with evolving demands.
Strong interpersonal skills, demonstrating discretion, empathy, and patience.
Robust written and verbal communication skills.
Strong organization and creative problem-solving skills.
Self-motivated.
Proficient in MS Office Suite and the use of Electronic Medical Records.

Nice To Haves

Experience working in a Skilled Nursing Facility setting is preferred.

Responsibilities

Conduct psychosocial assessments at regular intervals for ongoing determination of resident needs.
Provide psychoeducation and counseling to residents and family members regarding resident conditions, needs, and welfare.
Document resident assessments and encounters accurately and in a timely manner.
Promote resident dignity, autonomy, and individual rights in a holistic approach throughout the care continuum.
Attend the Health Center’s morning Interdisciplinary Team meeting.
Assist with signing in and orienting new residents.
Complete all admissions paperwork with resident or responsible party within 48 business hours of admission.
Provide resident with admissions packet and ensure required information and insurance cards are properly filed and updated in the Electronic Health Record.
Review advanced directives and ensure these are on file.
Assist with resident orientation to the Health Center and review all services available, such as dietary, rehabilitation, behavioral health, and other ancillary services.
Facilitate Early Advantage admission agreement for Health Center admissions in collaboration with the Marketing Team.
Complete psychosocial assessments and develop a person-centered Care Plan for psychosocial well-being as required at specific intervals, including but not limited to within 5-7 days of admission and on a quarterly basis.
Conduct relevant cognitive and mental health assessments in collaboration with the Interdisciplinary Team.
Accurately document resident visits, assessments, care plans, and other social work interventions within the Electronic Health Record.
Collaborate with the Interdisciplinary Team for resident care planning and participate in resident care plan meetings as scheduled.
Provide education, support, and facilitation of end-of-life care.
Serve as the liaison between the resident and family and any relevant ancillary services to ensure quality continuity of care.
Arrange and facilitate discharge planning when it is determined by the IDT that a resident is ready to discharge to a lower level of care.
Communicate between residents, family members, and Carolina Meadows to advocate for appropriate resident supports and care transitions.
Coordinate appropriate referrals upon discharge, such as to home care, home health, hospice/palliative care, medical providers, etc.
Ensure provision of recommended Durable Medical Equipment.
Confirm medication and prescription needs are met.
Provide psychoeducation and resources regarding resident’s continued care needs.
Coordinate transportation services upon resident’s discharge.
Submit and monitor the We Care Connect survey once the resident discharges.
Receive, manage, document, and ensure proper and timely follow-up of grievances.
Participate in QAPI meetings, providing information relevant to resident care, mood, and behavior.
Manage internal resident room change processes and notify the Health Center’s IDT when a resident becomes permanent to the facility.
Facilitate move-out process with a resident’s family/Responsible Party upon their death.
Coordinate facility’s sympathy card signing and mailing.
Act as a liaison between the Health Center and the consulting services in conjunction with the IDT.
Assist with initiating Long-term Care Insurance claims and submit monthly LTC Insurance continued care forms.
Attend the Health Center quarterly Family Night events.
Monitor residents for needs related to life transitions and adjustments.
Attend Interdisciplinary Team meetings to address person-centered approaches to resident needs, such as weekly PAR meetings and The Fairways morning meetings.
Provide psychosocial support, counseling, and psychoeducation to resident and family members related to residents’ diagnoses, treatment plans, and overall welfare.
Integrate Social Work values, ethics, and best practices into approaches to resident care.
Facilitate informational groups or psychotherapeutic support groups for residents experiencing stress, adjustments, grief, or other identified areas of concern.
Assist residents and family members with accessing available supports within the Carolina Meadows community.
Provide information about referrals to medical, community, financial, and other relevant resources available.
Participate in staff development and training opportunities that promote professional growth and the ability to remain knowledgeable about best practices in Social Work.
Establish and nurture a professional network within the Carolina Meadows organization and with community partners.
Maintain detailed and accurate documentation of work efforts, policies and procedures, and work performance as required to demonstrate measurable goals of resident support.
Additional Duties as Assigned.