Social Worker

Fresenius Medical Care•Benton Harbor, MI

14d

About The Position

Provides psychosocial services to patients treated by the facility, including in-center and home dialysis patients when applicable, using social work theory and accepted methods of practice. Works with the health care team to promote positive adjustment, rehabilitation, and improved quality of life. In collaboration with the interdisciplinary team, informs, educates, and supports staff in understanding the emotional, psychological, and behavioral impact of chronic kidney disease on patients and families to support comprehensive quality care. Supports the company’s quality indicators, outcomes, quality assessment and improvement activities, patient satisfaction, and quality-of-life goals. This is an entry-level MSW role. The Social Worker assesses patients’ psychosocial status, strengths, and needs; participates in care planning; provides counseling, education, referrals, and psychosocial interventions; and documents interactions and interventions. The role supports patient adjustment to dialysis, treatment adherence, rehabilitation, transplant-related education and referrals, advance-care planning, and access to community, vocational, insurance, and financial resources. The Social Worker participates in quality reviews and team activities, educates patients and staff, and supports patient admission and continuity of care.

Requirements

Master’s degree in Social Work.
Must have a state temporary license, Registered Social Worker Clinical Intern credential, Associated Social Work license, or Provisional LCSW license if required by the state.
Obtain necessary state licensure 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 as part of the comprehensive patient assessment.
Collaborate with patients and the interdisciplinary health care team on care planning and effective interventions to support rehabilitation, treatment goals, and quality of life.
Use patient education programs, social work theory and methods, focused interventions, and quality-of-life measurement instruments to address barriers and treatment goals.
Monitor patients’ adjustment to dialysis and provide interventions to support optimal psychosocial status and quality of life.
Provide supportive counseling within the scope of clinical training and state licensure.
Provide education and goal-directed counseling to patients seeking a transplant.
Refer patients to community resources, including home health services and vocational rehabilitation, and assist with access to those resources.
Maintain knowledge of local vocational and educational rehabilitation programs and help patients access them to remain employed, become employed, or pursue education.
Assess patient awareness of advance directives and assist with forms, information, and discussions with the health care team and family or support persons as needed.
Participate with the physician and nurse in discussions of patient DNR status to support informed decisions by patients and/or families.
Follow social work and patient physical and mental function policies, including documentation requirements; document interactions and interventions involving patients and/or families.
Provide psychosocial support and 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 quality indicators related to adherence, missed or shortened treatments, quality-of-life trends, and service recovery.
Assess patients’ knowledge of kidney disease and barriers that may affect treatment adherence.
Tailor patient and family education to learning styles, communication barriers, and needs; provide information about treatment modalities with the interdisciplinary team.
Facilitate transplant referrals and collaborate with the team on transplant waitlist management.
Educate patients and families about psychosocial issues related to ESRD and available support services.
Review patient rights and responsibilities, grievance information, and facility policies with patients or their representatives.
During admission and continuity of care, review required handouts and policies, address immediate needs, and support scheduling to maximize adherence and adjustment.
Interview patients requesting discharge to identify underlying concerns and share them with operational leadership.
Liaise with Insurance Coordinators regarding insurance issues and educate patients about dialysis payment sources and assistance programs.
Inform the Insurance Coordinator of patient status changes affecting insurance, such as transplantation, discharge, loss of coverage, or extended travel.
Refer patients to the patient billing solutions department for questions or concerns about treatment-related bills.
Assist with personnel interviews and hiring decisions when requested by the SW Manager or Senior Manager.
Work with administrative support staff to maintain current patient resource lists, including transportation resources.
Provide staff training on psychosocial topics as needed, participate in weekly team huddles, and discuss urgent patient issues with staff.
Follow caseload guidelines based on state regulatory requirements and work under appropriate supervision where required by state law.
Perform other related duties as assigned.