POSITION SUMMARY: In accordance with Agency standards and policies, prepares social histories, provides social casework to clients and families experiencing difficulty in social frameworks. Advocates for referrals to appropriate community resources. Consults and coordinates services with other agency health providers. Assists in development and implementation of health maintenance services, encouraging holistic health care of serviced communities.
Conducts psychosocial assessment of the client and family and develops a plan of care and realistic psychosocial goals.
Assumes primary responsibility for a patient/family caseload that includes the assessing, planning, implementing and evaluation of the psychosocial components of the patient's plan of care.
Prepares social histories to augment service provision, taking into consideration individual and family coping mechanisms, family relationships and dynamics, the meaning of illness to client and family, assessment of the importance and realities of home care provisions and the financial impact of illness on the family.
Provides social work therapeutic intervention through counseling, education and bereavement support to client and family to maximize strengths and coping capacity.
Promotes client self-determination and self advocacy
Assists in negotiating fiscal systems, particularly government entitlements
Considers factors related to safety, effectiveness and cost in planning and delivering patient and family care
Supervises non-LICSW level social workers when necessary
Provides continuous evaluation and monitors services through documentation and consultation.
Provides for assistance and advocacy with other community and agency resources as indicated.
Participates in agency team meetings and case conferences identifying social problems and assisting in development of health care plan and coordination of services.
Consults with staff regarding client care plan concerns; illustrating family dynamics and alternative methods of intervention.
Documents in the electronic medical record per agency standards to ensure accurate retrieval of quality indicators
Demonstrates knowledge of agency policies, Joint Commission Standards, Medicare Conditions of Participation and state regulations.
Provides clear documentation in the EMR (PTCT) so that problems, plans, actions and goals are accurately and clearly stated and changes can be reflected accurately by all members of the team in the plan of care
Interprets social resources to agency staff and health services to social agencies.
Provides in-service programs to agency staff as requested.
Participates in staff education series as appropriate.
Participates in development and implementation of new programs and services as requested.
Participates in clinical record review for medical social work services.
Works flexible schedule, including weekends, to meet patient and family needs
Facilitates adult and children's bereavement groups as required.
Current Massachusetts professional LICSW license
Master's Degree in Social Work
Strong customer service skills required
3-5 years experience in community health service or medical social service agency
Hospice and or home care experience strongly preferred
KNOWLEDGE AND ABILITIES:
Ability to read, write and speak English.
Knowledge of social work methods with particular skill in casework and ability to adapt this knowledge to a public health setting.
Ability to communicate effectively with intra and inter-disciplinary professionals
Ability to work with a framework of social work consultations and/or supervision commensurate
with one's experience.
Ability to work in a variety of settings: homes, group homes, skilled nursing facilities and assisted living facilities
Ability to maintain positive attitude despite constant exposure to personal and professional loss
The Jordan Health Systems Inc