Reference #: JR23-06868
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The Social Worker comprehensively plans for the coordination of care for the WVU Medicine patient population across the continuum. Performs resource management, discharge planning, care facilitation, and referrals to alternate levels of care. Works collaboratively with the multidisciplinary care team to facilitate achievement of desired treatment outcomes. The social worker intervenes with patients 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. In addition, may offer crisis intervention to patients and families with psychosocial needs and collaborates with the patient care team in the development of a transition/discharge plan of care for all patients.MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Masters Social Work Degree required
2. Pennsylvania state criminal background check required, and Federal, if applicable, for DHHR BMS regulated area.PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. One to three years of experience preferred
2. LGSW/LCSW/LICSW certification in the state of Pennsylvania preferred.CORE DUTIES AND RESPONSIBILITIES:The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
Manages all aspects of transition/discharge planning for assigned patients in a timely manner
Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload
Monitors the patient's progress; intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective
Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning
Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team
Provides assessment and crisis intervention when necessary to patients and their families
Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning
Initiates and facilitates referrals to post-acute services- including but not limited to- Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities
Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family.
Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.
Working knowledge of patient's current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc.
Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives
Provides intervention in child/adult/elder abuse/neglect, domestic violence, guardianship (temporary/permanent), foster care, adoption, mental health placement ,child protection or sexual assault
Collaborate for appropriate resource and financial management which may include but is not limited to-financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination
Uses quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions
Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials
Fosters the integration of staff and/or students into the healthcare team
Exhibits professional behavior on a consistent basis
Required on call and weekend/holiday rotations as needed
PHYSICAL REQUIREMENTS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.WORKING ENVIRONMENT:The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.SKILLS AND ABILITIES:
Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues
Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change
Capable of independent judgment and action regarding psychosocial needs of patients.
Additional Job Description:Scheduled Weekly Hours:40Shift:Exempt/Non-Exempt:United States of America (Exempt)Company:UNTWN Uniontown HospitalCost Center:403 UNTWN Care ManagementAddress:500 W Berkeley StreetUniontownPennsylvaniaEqual Opportunity Employer/Protected Veterans/Individuals with Disabilities.
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The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)