The Medical Social Worker provides medical social services, also acts under the direction of a physician, and reports to the Patient Care Manager and/ or Executive Director. This position requires advanced education in social work. Utilizing their advanced educational background and clinical expertise, the Medical Social Worker provides a wide range of services to terminally-ill patients and families while consistently exercising judgment and discretion to determine the patient and familys unique spiritual/ cultural beliefs, strengths, coping skills, and pre-bereavement and anticipatory grief needs. Assessment is ongoing and the Plan of Care reflects the Medical Social Workers analysis of and conclusions regarding unique bio-psychosocial needs of the patient/ family. Interventions may include, but are not limited to education, support, individual/ family counseling, linkage to community resources/ services, and ongoing collaboration with the IDG and community health providers. Additionally, the Medical Social Worker will have the responsibility to provide clinical supervision and guidance to the Social Services Coordinator and will review and determine, using discretion and judgment, whether each developed Plan of Care appropriately addresses the unique needs of the patient, and sign each developed Plan of Care; the Medical Social Worker will also provide counseling services to both the patient and the caregiver(s) once referral is made by the Social Services Coordinator. Community outreach, community education, and bereavement support group services are also functions of the Medical Social Worker. Adherence to company policy, procedures, and regulatory compliance is required, and travel will be needed as necessary.
ATTRIBUTES / QUALIFICATIONS
The Medical Social Worker must be knowledgeable of and have the ability to:
Uses discretion and judgment to support patients and their families with the complex emotional needs associated with terminal-illness, anticipatory grief, and bereavement by analyzing their needs to determine appropriate counseling and providing individual/ family counseling and therapeutic interventions as needed
Provide ongoing clinical supervision and professional guidance to the Social Services Coordinator, reviewing and determining, using discretion and judgment, whether each developed Plan of Care appropriately addresses the unique needs of the patient, and signing all developed Plans of Care.
Facilitate communication among patients, family members, and members of the IDG/ healthcare team
Recognize signs and symptoms of death and provide education/ support to family members in a manner guided by clinical assessment
Determine appropriate interventions and goals for the patient and family based on clinical assessment
Advocate for needed services and support on behalf of the patient and family
Navigate complex social systems/ networks to obtain resources and link the patient and/ or family members to appropriate services
Serve as a liaison for the patient and family and collaborate with IDG members and other healthcare/ community providers
Understand family dynamics and patterns styles for communication and/ or decision making
The Medical Social Worker must be knowledgeable of the professional and ethical standards set forth by governing bodies (professional associations, educational counsels, healthcare accreditation), must possess knowledge of the Hospice philosophy and culture, value quality, competent care, and understand the general principles of end-of-life care and death/ dying. The Medical Social Worker must also be able to demonstrate excellent written and verbal communication skills and display professional judgment at all times. Reasonable accommodations will be made to enable individuals with disabilities to perform these essential duties.
REQUIRED EDUCATION / EXPERIENCE
Masters degree in Social Work (MSW) from a school of social work accredited by the Council on Social Work Education (CSWE), one year minimum social work experience in a health care setting and current licensure and / or certification as required by the State. Prior supervisory experience preferred.
1.* Abides by and demonstrates the company Mission Vision Values through both behavior and job performance on a daily basis.
2.* Conducts an initial biopsychosocial assessment that focuses on the dynamic needs of the patient and family (support system) and provides ongoing assessment to address the evolving emotional, spiritual, and physical needs.
3.* Develops and implements a Plan of Care that addresses the biopsychosocial needs of the patient and family and takes into account unique spiritual, cultural, religious, and other relevant factors that influence the family system.
4.* Assesses and treats pain from a psychosocial perspective that involves ongoing assessment, discussion of self-determination in pain management, development of specific goals and interventions that maximize the patients/ familys strengths, and skill development to handle other concurrent stressors that may exacerbate pain.
5.* Identifies psychopathology and other relevant behavioral issues within the patient and family system, assesses and explores past coping strategies/ previous losses/ co-occurring stressors, and provides counseling (short-term) and education.
6.* Supervises the Social Services Coordinator(s) through ongoing discussion and review of the biopsychosocial assessment and subsequent Plan of Care; reviews and uses independent judgment and discretion in determining whether each developed Plan of Care appropriately addresses the unique needs of the patient and signs the Plan of Care developed by the Social Services Coordinator; conducts periodic home visit supervision and/ or clinical record review
7.* Assists patient and family with Do Not Resuscitate status, Advanced Directives, and other personal and / or legal directives as needs are determined.
8.* Provides ongoing education and support regarding end-of-life issues and death, dying, and bereavement.
9.* Assists the family / caregiver in the placement / transfer of patient to a facility (i.e., SNF, ALF, Hospital) for basic care needs, when appropriate, and provides case management and discharge planning as needed.
10.* Completes and maintains all patient records. Keeps a copy of the clinical documentation at the patients place of residence. Submits accurate and relevant clinical documentation (assessment, plan of care, clinical visit notes) that relates to the patient and support systems overall condition and that relates to the prevision of care given, interventions, goals and outcomes.
11.* Attends and actively participates in Interdisciplinary Group meetings (IDG), staff meetings and in-services; actively contributes to quality out-come measurements related to patient care planning requirements.
12.* Provides for and assists with the education and maintaining of a safe environment for the patient.
13.* Participates in evening / weekend call as required, conducting on-call services in a professionally competent and responsive manner.
14.* Maintains clinical records, statistics, reports and records for purposes of evaluation and reporting of agency activities as prescribed and in compliance with local, state and federal laws.
15.* Maintains a reasonable caseload and delivers care in a cost-effective manner that demonstrates an understanding of hospice reimbursement methodologies.
16.* Assures compliance with local, state and federal laws, Medicare regulations and established personnel policies and procedures.
17.* Adheres to and participates in the Companys mandatory HIPAA privacy program/ practices, business ethics, and compliance programs / practices. Assures privacy of the patient and family, sharing information with IDG members respectfully, professionally, and as needed. Maintains confidentiality at all times.
18.* Reviews and adheres to all Company policies and procedures and the Employee Handbook.
19.* Participates in special projects and performs other duties as assigned.
Kindred is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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