AddressAs a member of the Shore Community Outreach Team the Social Worker provides comprehensive in-home and telephonic psychosocial assessments and care coordination to patients referred to the program. The Social Worker also works with community agencies, colleagues, and community members to develop and implement community outreach events. The Social Worker is actively involved with community organizations and other healthcare providers as an advocate for both patients and the hospital system.
I. General Summary
Independently practices social work and receives limited consultation, functioning as a member of the multidisciplinary healthcare team to provide case management, therapeutic crisis intervention, biopsychosocial assessment, clinical evaluation, therapy, counseling, referral, treatment planning, and other Clinical Social work services within their practice area.
II. Principal Responsibilities and Tasks
The following statements describe the general work performed in this role. It is not an exhaustive list of all duties that may be performed.
- Completes specialized assessment(s) in a focus area/practice setting, as needed. Provides feedback regarding the enhancement of assessment tools within their area. May provide consultation to other Social Workers about their assessments.
- Offers psychosocial guidance, with their advanced ability, to help settings enhance their clinical practice.Drives conversations about Advance Care Planning to healthcare team.
- Provides advanced ongoing and crisis care to facilitate a therapeutic and safe environment for patients. Serves as a professional resource to other members of care team.
- Suggests/initiates PI projects to evaluate program and outcome effectiveness.
- Demonstrates advanced knowledge and skillsets necessary to provide care appropriate to the age, culture, ethnicity, spirituality, and individual diagnostic needs of the persons served.
- Demonstrates advanced knowledge of relevant resources to share with team members & initiates networking based on program gaps. Serves as a lead contact for complex patient cases.
- Empowers patients and the practice area with problem-solving and decision-making around personal, health, social, educational, vocational, financial and other interpersonal concerns within context of discharge planning, clinic visit, or on-going behavioral health assistance.
- Functions independently with daily work and models acceptance of peer feedback.Provides consultation and assistance with challenging cases to other Social Workers.
- Conducts clinical reviews of assessments, planning, interventions, and overall plan of care to provide peer feedback.
- Demonstrates advanced ability to provide education to patient and peers that aligns with the NASW Code of Ethics.
- Demonstrates ability to independently advocate for self and team members.
- Participates in a council and/or a committee within the healthcare system.
Participates in conversations about unit practice & provides recommendations for improvement.
- Completes all specific job tasks within their assigned department as outlined by supervisor.
