Summary of Essential Functions
The Licensed Master Social Worker systematically intervenes to provide clinical social work and complex discharge planning to patients and their families who have complex psychosocial needs, require assistance with eligibility determination for social programs and funding sources and qualify for community assistance from a variety of special funds and agencies.
Under the supervision of a licensed clinical social worker, offer crisis intervention and/ or mental health assessment to patients and families with psychosocial needs and coordinates and facilitates the development of a multidisciplinary discharge plan of care for high-risk patient populations.
Participates in an interdisciplinary team (including Physicians, Case Managers, Staff Nurses and other members of the care team) to provide services for individuals from at-risk population and ensure that psychosocial issues are attended to and treated as required across the continuum of care.
Reports to the Manager of Social Work
This position will provide support to patients and families receiving palliative or hospice care. Position will cover both Clinic and hospital coverage.
Educational Requirements
Graduate of an accredited Master of Social Work program (MSW)
High school diploma or equivalent required.
Must be able to communicate effectively in English, both verbally and in writing.
- Licensure and Certifications
- Current license as a Master Social Worker (LMSW) or higher in the state of Texas required;
- CCM certification from Commission for Case Manager Certification strongly preferred.
- ACM certification from American Case Management Association (ACMA) preferred
- Knowledge/Skills/Abilities
- Experience in an inpatient setting is highly desired. Experience with hospice and palliative care patients a plus.
- Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served.
- Must demonstrate knowledge of Mental Health assessment and treatment as well as understanding of principles of growth and development as it relates to the different life cycles
- Field placement or internship in health services/health care provider experience
- Acute inpatient hospital social work experience preferred
- Effective oral and written communication skills
- Working knowledge of DSM V and ICD-10 manuals
- Demonstrates knowledge and skill in social work assessment and treatment of patients for mental health status and substance abuse screening
- Excellent therapeutic communication and negotiation skills in interactions with patients, families, physicians and health care team colleagues
- Strong analytical skills
- Working knowledge and/or experience in utilization management, managed care, and payer issues
- Exposure and/or experience in pre-acute and post-acute care, as well as, community resources
- Ability to work independently, as well as, to develop collaborative relations with physicians, families, patients, interdisciplinary team and other community agencies
- Effective oral and written communication skills
Physical Requirements
Primarily works the day shift tour of duty; additional hours may be asked to work other hours as needed, including weekends.
May be expected to lift over twenty five (25) pounds.
Ability to distinguish between numbers and symbols.
Hand-eye coordination and manual dexterity with substantial movement of wrist and/or fingers.
Walking and climbing to accomplish tasks.
Corrected vision and hearing to normal or near normal range.
Extended periods of sitting and/or walking depending on specific duties.
Duties and Responsibilities
- Assesses patient's 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.
- As part of a multidisciplinary team, develop and carry out a treatment plan by the use of a clinical social work diagnoses, assessments, and treatment interventions.
- 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. Under supervision this may include short term individual, marital and family therapies as well as crisis intervention
- Provides intervention in cases involving child abuse/neglect, domestic violence, guardianship (temporary/ permanent), institutional abuse, foster care, adoption, mental health placement, advance directives, adult/elderly abuse, child protection and sexual assault.
- Serves as a resource person and provides counseling and intervention related to treatment decisions and end-of-life issues.
- 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 discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers.
- Deals with families exhibiting complex family dynamics that impact directly on patient care and discharge.
- Communicates with clinical care team members regarding the discharge planning status of all patients referred by them.
- Provides consultation to Case Managers when coordination with significant or intensive community resources is necessary to achieve desired treatment outcomes.
- Receives referrals for complex patient problem resolution from Case Managers or clinical care team members.
- Works in collaboration with the clinical and case management team members on transition planning and referrals to post acute care providers. Keeps clinical and case management team members up-to-date on the status of the post-acute provider acceptance and clearance for discharge.
- Validates discharge criteria for patient and families and notifies clinical and case management team members of newly-identified resources or change in previously-identified resources.
- Educates patient/family and physician regarding post-acute options and addresses issues of choice.
- Ensures safe care to patients, staff and visitors; adheres to all United Regional policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
