Social Worker Comm Palliative Care

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Job Summary:
The Social Worker is responsible for the oversight and coordination of quality patient care and participates in staff team conferences and communication. This position assesses the social and emotional factors related to the patient's illness and evaluates the psychosocial response to treatment and level of adjustment. This position interprets to the family, patient, physician, and staff, the social and emotional factors related to illness, financial and community resources. Acts as a liaison between the patient, family, the palliative medicine team, outside agencies and their representatives. Communicates and collaborates with the interdisciplinary team members. Reviews all new patient charts for appropriate diary of all current patient charts to assure quality, cost effective services; outcome measures data retrieval for statistical purposes; compliance with documentation standards; trending of patient services data to measure quality of care and cost of care. May be required to conduct educational presentations for incorporating case management into all aspect's outpatient palliative medicine.
The Case Manager will provide services to assist the patient/family with resources, information, and counseling services to benefit their adjustment to illness, hospitalization, anticipatory grief, death, and bereavement. Work as a part of an interdisciplinary team to provide care and support to the patient and family and serve as an expert for issues related to psychosocial issues in end-of-life care, documentation, and healthcare standards. Maintain a caseload of patients/families in Palliative Care. Assist with the admission process to hospice and initiate conversations about advanced directives.
Adheres to professional standards, codes of ethics, system department policies and procedures.
Core Responsibilities and Essential Functions:
Case Management
- Reviews all new referrals for completeness to assure appropriateness.
- Communicates with the team regarding progress.
- Coordinates team goals, the interdisciplinary team conferences, and the family education process to assure a smooth flow of care until discharge.
- Executes various documents with the patient and family as needed.
- Executes various documents with the patient and family as needed.
- Care coordination and follow-up with patient, family, team, and physicians. Counseling
- Provides counseling to patient and families.
- Implements clinical standards.
- Assess psychosocial needs of patient, family, and caregivers
- Facilitates problem solving with patients and families.
- Works with families to assure appropriate resource identification, access, and utilization.
- Assist with the transitions to different level of care, location of care, or transfer/discharge to/from hospice. Communication
- Communicates with referring physicians to facilitate and facility to assure appropriate care level.
- Serves as a resource for the interdisciplinary team, regarding complex patient/family dynamics and end of life care.
- Communicates to all stake holders regarding patient progress.
- Meets with patients, families, team members and outside case managers to review patient progress.
- Provide community education in the areas of death, dying and bereavement. Compliance
- Assures documentation meets regulatory standards.
- Participates in chart audits as requested.
- Works with physician and interdisciplinary team to assure regulatory and TJC compliance.
Required Minimum Education:
Master's Degree in Social Work from accredited school of social work.
Required
Required Minimum License(s) and Certification(s):
Lic Clinical Social Worker GA 1.00 Required
Lic Master Social Worker GA 1.00 Required
Basic Life Support 2.00 Required
BLS - Instructor 2.00 Required
BLS - Provisional 2.00 Required
Additional Licenses and Certifications:
Required Minimum Experience:
Minimum of 1 year experience in mental health, behavioral health, Palliative Care and/or medical case management. Required and
Must have knowledge of community resources and experience end of life disease management. Required
Required Minimum Skills:
Demonstrated skills or experience in case management.
Strong computer skills required
Good communication skills both verbal and written.
Excellent time management/organizational skills; working knowledge of precertification process is preferred and working knowledge of medical terminology.
Possess knowledge of development characteristics of people of all ages, economic backgrounds and cultural backgrounds.
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