About the position
The Social Worker II collaborates with individuals, families, and groups to address psychosocial challenges through a process of assessment, diagnosis, treatment, and evaluation. As part of a multidisciplinary care team, this position works directly with patients and their caregivers to resolve personal crises and support a therapeutic milieu to cope with chronic, acute, or terminal illnesses. The Social Worker is also responsible for overseeing the general case management and care coordination of assigned patients.
Responsibilities
- Develop discharge plans, identifying the post-discharge needs of the patient and target appropriate resources for follow-up care, in collaboration with the patient, family and multidisciplinary care team.
- Integrate insurance, financial situation and criteria for payment in discharge plans in consideration of patient/caregiver needs.
- Maintain accurate, concise and timely documentation in EPIC and DOC flowsheets for discharge planning.
- Maintain good rapport with internal and external referral sources; facilitates communication with community facilities, agencies, and resources and makes appropriate referrals as needed.
- Document patient care information and ensures timely and accurate completion of patient care records in accordance with policies and procedures.
- Collaborate with a medical case manager and multidisciplinary treatment team to individualize each patient's treatment needs in order to achieve defined goals for improved patient outcomes.
- Educate patients and their caregivers about extended care facilities, home health agencies and other resources as appropriate, to transition patients along the continuum of care.
- Assess social determinants and barriers to discharge from the previously established discharge plan for readmitted patients.
- Perform thorough patient psychosocial assessments to explore the physical, psychological and social aspects of the patient and their conditions.
Requirements
- Indiana LSW or LCSW required
- Master's Degree in Social Services field required
- 2 years of Acute Care Hospital, Mental Health, or related Community Healthcare experience preferred
