February 14, 2022

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Job Title: Social Worker

Job Code: F02163

FLSA Status: Non-Exempt

Date: April 2021

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GENERAL SUMMARY:

The Social Worker is responsible for creating outcomes for the patient and family by managing complex psychosocial and economic co-morbidities. Provide education and consultation regarding resources, collaborate to develop a discharge plan and facilitate and monitor its implementation. Assist patient/family adjust to and cope with illness, diagnosis, treatment options and prognosis. Through advanced practice skills mobilizes resources to reduce risk, serves as a liaison between the hospital and the community. In addition offers crisis interventions to patient/family.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

Psychosocial Assessment and Interventions

1. Based on preliminary risk screening, assesses patients and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.

2. Appropriately documents in ECIN or medical, record those patients identified as high risk for readmission.

3. Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.

4. Provides intervention in cases involving child abuse/neglect, domestic violence, elderly abuse, institutional abuse and sexual assault.

5. Serves as a resource person and provides counseling and intervention related to treatment decisions and end-of-life issues.

Complex Discharge Planning

1. Participates in discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers.

2. Deals with families exhibiting complex family dynamics that impact directly on patient care and discharge.

3. Communicates with the healthcare team regarding the discharge planning status of all patients referred by them.

4. Assists RN Case Managers or appropriate team members with discharge planning activities as requested.

5. Provides consultation to RN Case Managers or appropriate team member when coordination with significant or intensive community resources is necessary to achieve desired treatment outcomes.

6. Receives referrals for complex patient problem resolution from RN Case Managers or care team members.

7. Screens and coordinates referrals to the next level of care i.e.: SNF, LTAC, HHC, Hospice and Rehab. Validates discharge criteria for patient and families and notifies RN Case Managers or appropriate team member of newly identified resources or change in previously identified resources.

8. Educates patient/family and physician regarding post-acute options and addresses issues of choice.

9. Identifies the need for and conducts family meetings that result in informed decisions and other outcomes.

Patient and Family Support in Legally Complex Cases

1. Provides intervention in child abuse/neglect, domestic violence, guardianship (temporary/ permanent), foster care, adoption, mental health placement, advance directives, adult/elderly abuse, child protection and sexual assault.

• Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals, which contribute to the success of the organization.
• Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
• Participates in care conferences and collaborative rounds.
• Actively participates in clinical performance improvement activities as assigned.
• May provide supervision of Social Worker Interns, MSWs with less than 4,000 hours of hospital experience, ensuring requirements mandated by the State of Michigan. Provides mentorship to all levels of social work in current social trends and practice.

EDUCATION/EXPERIENCE REQUIRED:

• Masters Degree in Social Work.
• Social work or protective services experience preferred.
• Working knowledge/experience in utilization management, managed care and payor issues preferred.
• Experience in psychosocial and therapeutic counseling preferred.
• Ability to interview, assess, organize and problem solve. Ability to identify appropriate community resources on assigned caseload and to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes.
• Possess interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues. Possess analytical, data management and PC skills. Exposure and/or experience in pre-acute and postacute care, as well as community resources. Ability to work independently, as well as to develop collaborative relationships with physicians, families, patients, interdisciplinary team and other community agencies. Ability to analyze, develop and manage change; to integrate Continuous Quality Improvement principles for service and organization work improvements.
• Ability to work with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change. Demonstrates the ability to connect patients and families with necessary services, both inside and outside the HFHS.
• Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources. Must demonstrate patience and tact when dealing with patients, families and other staff.

CERTIFICATIONS/LICENSURES REQUIRED:

LMSW with clinical specialty or clinical/macro specialty licensure required.

Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy and summarized below:

• Communication
• Ownership
• Understanding
• Motivation
• Sensitivity
• Excellence
• Teamwork
• Respect

Must practice the customer skills as provided through on-going training and in-services.

Must possess the following personal qualities:

• Be self-directed
• Be flexible and committed to the team concept
• Demonstrate teamwork, initiative and willingness to learn
• Be open to new learning experiences
• Accepts and respects diversity without judgment
• Demonstrates customer service values

PHYSICAL DEMANDS/WORKING CONDITIONS:

Normal office environment with minimal exposure to noise, dust, or extreme temperatures

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