Social Worker Intake PRN

Position Responsibilities :

· Evaluates the psychosocial needs of patients and family support systems and coordinates appropriate discharge plans for identified patient populations.

· Acts as a liaison between the facility and resources external to the organization.

· Facilitates the implementation of timely discharge plans and facilitates follow-up to anticipated post-acute interventions identified in the plan of care.

· Provides crisis intervention and support.

· Identifies and tracks barriers to patient throughput.

· Completes the social services section of the treatment plan.

· Coordinates treatment team meetings between the physician and disciplines.

· Coordinates discharge plans with attending physician or designee

Department Specific Criteria :

· Performs a comprehensive assessment of psychosocial needs of assigned patients.

· Involves patient, family/responsible/significant others, develops, implements, monitors and revises plan of care in collaboration with the interdisciplinary team

· Assesses patients discharge needs and facilitates the provision of services necessary to meet identified needs.

· Performs home health referrals, intermediate care and skilled nursing facility referrals.

· Assists patients with medication acquisition, facilitates follow up appointments, arranges public transportation, etc.

· Evaluates suspected abuse and neglect referrals; makes official reports to state and regulatory or legal agencies as required by statue or facility policy

· Develops an individual plan of care for recurring patients to include education related to accessing healthcare services at the appropriate level of care; preventative education, and community based resources.

· Provides assistance with access to medication assistance programs

· Provides education to the under-resourced patient/family of potential and available resources.

· Identifies needs, coordinates the development of realistic plans which include patient/family centered goals, facilitates implementing plan, and performs follow-up evaluation

· In collaboration with the interdisciplinary team, develops, implements, evaluates, revises as needed, a discharge plan to include identified psychosocial and discharge needs

· Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team

· Facilitates the interdisciplinary team (as assigned) to ensure psychosocial and discharge needs are addressed; plan, interventions and patient/family/MD concurrence will be documented

· Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies

· Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives.

· Monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Social Services

· Facilitates patient throughput with an ongoing focus on quality outcomes and an efficient transition between levels of care. Tracks and trends barriers to care.

· Makes recommendations and develops action plans to improve processes and systems

· Provides psychosocial support to patients and families through crises intervention

· Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered

· Acts as an advocate for identified needs and makes appropriate referrals; abuse and neglect, substance abuse/overdose, homelessness, post-partum patients < 17 years of age, fetal demise, mother-baby bonding, adoptions, guardianship, etc.

· Acts as a liaison between the facility and community resources to enhance community outreach coordination.

· Establishes and maintains resource database, educates peers and patients on resources, performs community outreach as directed

· Tracks and trends variances barriers related to access to care; makes recommendations and develops action plans to improve processes and systems

· Adheres to established policy and procedure and standard of care; escalates issues through the Chain of Command

Qualifications:

· Master’s degree in Social Work, Counseling, or related behavior science is required

· Knowledgeable of minimum requirements for accrediting bodies, Joint Commission, state and regulatory requirements related to service delivery in the facility

· BLS – American Heart Association - required

· Crisis Prevention within 60 days of hire or transfer

· Social Work experience; acute care case management experience preferred

· Ability to establish and maintain collaborative and effective working relationships

· Ability to communicate effectively in oral, written and electronic formats

· Demonstrates analytical and critical thinking abilities with pro-active decision-making and negotiation skills

· Demonstrates an ability to perform specific competencies as identified