Social Worker- Full Time, Day in Medway

As a Social Worker, you play an important and trusted role in the lives of patients and their family. You are an integral part of their care and recovery.

Position: Social Worker

Location: Wegman Family Cottages - PRLC

Department: Transition Care Center

Schedule: Monday-Friday 7:30am-4pm

Hours: Full time 40 per week

Attributes:

• One (1) year of experience in a healthcare setting preferred
• Compassionate, warm and patient focused
• Exceptional documentation and planning skills
• Excellent communication and interpersonal skills

Responsibilities:

• Patient Care: Determine patient needs through rounds, chart review, patient/family interviews and team conferences; coordinate multidisciplinary and agency case conferences; work with care managers to advocate for patient/family to obtain approval for insurance coverage.
• Referral Management: Manage referrals related to patients at risk and determine appropriate intervention strategies and document as implemented; ensure inappropriate referrals are channeled correctly and documented.
• Treatment Plan Development: Coordinate assessments and develop care plan in accordance with accepted social work policy; implement plan of intervention preparatory to discharge or initiate continued care plan.

Key Responsibilities:

• Manage referrals related to patients with psychosocial needs and determine appropriate interventions and strategies to meet those needs.
• Review track board census or documentation to identify high risk patients not referred.
• Document social work intervention.
• Assess patient needs and determine mode of intervention.
• Interview patients and/or families and record psychosocial assessments in accordance with the social work documentation policy.
• Coordinate multidisciplinary and agency case conferences as needed.
• Implement plan of intervention preparatory to discharge or initiating continued care plan in compliance with departmental and governmental regulations.
• Work with care manager, acting as intermediary with Health Care Insurance providers, advocating for patient/family.
• Involve patient/family in the treatment planning process.
• Execute plan of discharge/continued care which is mutually agreeable to patient/family.
• Notify involved parties concerning the discharge, within 24 hours of receipt of discharge authorization.
• Request needed paperwork from nursing/doctor and other disciplines.
• Arrange for transportation of patient where needed in accordance with hospital procedure.
• Act as liaison with the community and as a referral source.
• Perform other duties as assigned.

ElderONE Housing Coordination Responsibilities:

• Eliminate wasted bed days in the hospital and skilled nursing facility that are due to housing barriers.
• Build effective relationships to create housing options for ElderONE.
• Coordinate with interdisciplinary teams, discharge planners and other partners to ensure well-coordinated and timely discharges/transitions into housing.
• Assist participants with all aspects of establishing housing.
• Create proactive mitigation plans that prevent the need to use skilled nursing or unnecessary higher levels of care.
• Work with contracted and non-contracted skilled nursing facilities to provide housing options for patients.

Minimum Qualifications:

• For those hired on or before December 31, 2023, a Bachelor’s Degree in Social Work or related degree is required.
• For those hired on or after January 1, 2024, a Bachelor’s Degree in Social Work is required.
• New Graduates: Official transcript from accredited school or letter confirming program completion will be accepted upon graduation.
• Primary source education verification required within 90 days of start date.

Required Licensure/Certification: No specific licensure or certification requirements listed.

Education: BS: Social Work (Required)

Physical Requirements: Sedentary work - Exerting up to 10 pounds of force occasionally. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.

Pay Range: $25.50 - $35.00