Social Worker

Fresenius Medical Care•Benton Harbor, MI

16d

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 social work practice. Works with the healthcare team to promote positive adjustment, rehabilitation, and improved quality of life. In collaboration with the interdisciplinary team, supports staff in understanding the emotional, psychological, and behavioral impact of Chronic Kidney Disease on patients and families, and contributes to quality indicators, outcomes, patient satisfaction, quality of life, and process improvement activities. This is an entry-level MSW role. The Social Worker assesses psychosocial needs and strengths, contributes to care planning, provides counseling and education, connects patients with community resources, and supports treatment adherence and quality of life. The role also includes helping patients navigate transplant referrals, advance directives, DNR discussions, patient rights, admission and continuity-of-care needs, insurance and financial assistance issues, and relevant support services. The Social Worker collaborates with the interdisciplinary team, participates in quality reviews and team huddles, supports staff training as needed, and follows applicable policies, documentation standards, caseload guidelines, and state supervision and licensure requirements. Travel may be required when working across multiple facilities.

Requirements

Master’s degree in Social Work.
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 necessary 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.
Participate in care planning with patients and the healthcare team to identify interventions that 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 and provide interventions to support adjustment to dialysis and optimal psychosocial status and quality of life.
Provide supportive counseling within the scope of clinical training and state licensure.
Provide educational and goal-directed counseling to patients seeking transplant.
Provide information and assist patients and the team with referrals to community resources, including home health and vocational rehabilitation services.
Maintain knowledge of local vocational and educational rehabilitation programs and assist patients with referral and access.
Assess patient awareness of advance directives, help patients access forms and information, and facilitate discussions with the healthcare team and family or support persons when needed.
With the physician and nurse, participate in discussions of patient DNR status to support informed decisions by patients and/or families.
Follow FMCNA Social Work Policy and Measuring Patient Physical and Mental Function Policy, including documentation requirements.
Document MSW interactions and interventions provided to 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 on indicators related to adherence, missed or shortened treatments, quality-of-life trends, and service recovery.
Assess patient knowledge of kidney disease and barriers to treatment adherence; collaborate with patients, families, and the healthcare team on tailored education.
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.
Collaborate with the team on appropriate QAI activities.
Review admission materials and address immediate patient needs and concerns.
Support the referral and admission process, including scheduling needs that promote adherence and adjustment.
Interview patients requesting discharge to identify underlying concerns and share them with operational leadership.
Liaise with Insurance Coordinators to address patient insurance issues and provide education about dialysis payment sources and assistance programs.
Notify the Insurance Coordinator about patient status changes that affect insurance, including transplantation, discharge, loss of coverage, or extended travel.
Refer patients to the patient billing solutions department for treatment-related billing questions or concerns.
Assist with interviews and hiring decisions for new personnel when requested by the SW Manager or Senior Manager.
Work with administrative support staff to maintain updated patient resource lists, such as transportation resources.
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.