Clinical Social Worker Msw - Hospice House / Home Based Visits , Full Time -

Job Description

POSITION SUMMARY:Hospice House in Palm Bay & field/home based visits positionShift Time: 8 - 4:30pm ; Monday - Friday with rotating weekendsTo be fully engaged in providing Quality/No Harm, Customer Service and Stewardship by coordinating the psychosocial care and services for assigned patients in collaboration with the patient, family, physician, patient care team, and payers. The Social Worker utilizes advanced psychosocial skills to facilitate the coordination of care through assessment, planning, intervention and evaluation. The Social Worker promotes and evaluates the effective utilization of resources using current knowledge, awareness of community services, and serving as a role model to achieve optimal clinical and resource outcomes

PRIMARY ACCOUNTABILITIES:Quality/No Harm:

• Demonstrate knowledge of hospice philosophy and services, progression of terminal illness, cultural diversity, grief process and funeral planning.
• Conducts psychosocial assessment to screen for patients/families at risk for crisis, abuse, financial or environmental issues.
• Assess and document in electronic medical record patient/family needs and collaborates with interdisciplinary team to identify possible psychosocial needs.
• Documents professionally, accurately, timely and according to Hospice of Health First policies and procedures.
• Identifies and documents necessary transitional care needs (LTC facility, respite, and transfer to inpatient unit).
• Communicating with the patient/caregiver and interdisciplinary team regarding issues related to payer or financial issues.
• Coordinates and documents complex patient/family needs.
• Collaboratively determines desired end of life goals and communicates options to patient/family, physicians and staff members.
• Participates in patient care conferences/ethics consults to ensure coordination of care.
• Collaborates with RN Case Manager, ancillary staff and physicians facilitating continuity of care for the patient.
• Identifies "at risk" patient populations and/or strengths of patient/family support systems.
• Provides therapeutic/crisis intervention counseling with patients and families as needed.
• Provides supportive services for End of Life Issues, Terminal Care and Bereavement
• Provides counseling and researches placement options depending on patient's needs.
• Provides therapeutic interventions with patients and families as needed.
• Completes mandatory reporting processes.
• Identifies system/process breakdowns and improvement opportunities.
• Intervenes and recommends appropriate referrals to resolve barriers to patient progression, collaborating with other disciplines as directed.
• Assures compliance with regulatory standards of care at both the state and federal levels.
• Identifies risk management and quality issues and intervenes or refers as indicated.
• Adheres to the National Patient Safety Goals (i.e. use of two patient identifiers when assessing patient information and in the performance of job duties).

Stewardship:

• Communicates pertinent patient information and plan of care effectively to appropriate team members.
• Participates in patient care conferences as necessary.
• Participates in patient team conferences in assigned areas.
• Recommends supportive and therapeutic interventions as indicated to ensure a cost effective, safe and efficient plan of care and quality patient outcomes.
• Collaborates with other interdisciplinary team members to communicate plan of care.

Customer Experience:

• Reinforces and documents education with patient/family on psychosocial aspects of care and expected outcomes.
• Provides and documents education for members of the team regarding appropriate services and referrals available for patients/families.
• Maintains current knowledge and awareness of payer/reimbursement practices and regulations affecting the patient's plan of care.
• Initiates appropriate referrals to Ethics Committee, Risk Management or legal services as appropriate.
• Participates in resolution of legal issues such as guardianship, power of attorney, etc.
• Assists with the implementation of advanced directives.
• Demonstrates professional accountability through supporting patient's rights, informed consent and advanced directives.
• Associate supports engagement through adherence to the I-C-A-R-E Values.

Qualifications:

QUALIFICATIONS REQUIRED:
• MSW degree from a Council on Social Work accredited school

• LCSW Eligible and obtained within five (5) years of employment preferred.

• Three (3) years of previous social work experience preferred.

• Acute Care/Hospice/Home Care experience preferred. • Demonstrated computer experience.

PHYSICAL DEMANDS:

• Able to stand, walk, sit and travel large distances repeatedly, within a facility/hospital/patient home, in a timely manner

• Able to lift up to twenty (20) pounds unassisted up to five (5) times a day.

• Ability to hear, to understand patient, family and medical staff correctly.

• Must be able to communicate with patients, families and staff.

• Must be able to tolerate a minimum of 3-5 hours of computer time a day.

• Ability to cover weekends, holidays and on call.

MENTAL DEMANDS:

• Ability to deal with multiple demands in a short timeframe.

• Ability to meet deadlines.

• Be a self-starter.

• Committed to quality patient care.

• Committed to maintain professional standards of Social Work.

• Ability to work in a TEAM environment effectively.

• Ability to relate to and work with the ill, elderly and emotional individuals within the hospice and community settings with compassion and professionalism.