The Social Worker provides and oversees the provision of psychosocial care for selected patients and families. Conducts bio-psychosocial assessments, provides intervention and treatment as indicated. Identifies high‐risk psychosocial factors of patients/families that impact health status and helps staff understand the influence of those factors upon the course of medical care.
Requirements
- Participates in case reviews to evaluate case management and progress
- Consults with healthcare team members to promote, monitor, and evaluate compliance with patient's treatment plan
- Develops comprehensive bio-psychosocial assessments responsive to age appropriate and cultural needs and concerns
- Employs a range of clinical interventions such as adjustment to illness counseling, crisis intervention, care coordination, and information and referral and safety planning
- Advocates on behalf of patients and families to gain access to services and resources
- Provides assistance with entitlements, medications, transportation, and advance directives
- Performs all aspects of psychosocial discharge planning for chronic conditions and/or long-term custodial care needs for inpatient discharge, community services, outpatient care and any other applicable setting
- Supports the department's initiatives, mission and goals and may take on additional responsibilities at the discretion of leadership
- Provides psychosocial support and interventions, particularly for individuals with chronic and/or complex medical and behavioral health conditions
- Assesses patient/family learning needs, styles and readiness
- Educates patients/families based on treatment plan, identifies barriers to care, diversity issues and learning styles
- Responsible for outreach and coordination with other community resources and agencies, and community-level advocacy on behalf of patients and families
- Responds to requests for assistance with Social Determinants of Health and advocates for support in the community
- Refers to and collaborates with Memorial Healthcare System SDOH Hub
- Supports patients with mental health needs during the episode of care, discharge planning to both inpatient and outpatient mental health providers as applicable to the patients' healthcare setting
- Responsible for identification and referral for specialized services, such as drug and alcohol treatment, legal services, financial and employment counseling, and housing support
- Provides assessment and intervention in domestic violence and child abuse situations
Benefits
- Accountability
- Analysis and Decision Making
- Crisis Intervention - Behavioral Health
- Customer Service
- Patient and Family Centered Care
- Problem Solving
- Responding to Change
- Standards of Behavior
