POSITION
DESCRIPTION
|
POSITION
SUMMARY: 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. |
LGSW/LCSW/LICSW certification in the state of West Virginia
required |
PREFERRED
QUALIFICATIONS: |
|
EXPERIENCE: |
|
1. |
One to three years of experience
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. |
|
1. |
Manages all
aspects of transition/discharge planning for assigned patients in a timely
manner |
2. |
Collaborates
with all members of the multidisciplinary team to facilitate the
transition/discharge process for designated caseload |
3. |
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 |
4. |
Provides
education as needed to staff, physicians, and patients and their families to
ensure effective transition planning |
5. |
Meets
directly with the patient and/or family to assess needs and develop an
individualized transition/discharge plan in collaboration with the physician
team |
6. |
Provides assessment
and crisis intervention when necessary to patients and their families |
7. |
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 |
8. |
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 |
9. |
Communicates
all necessary information regarding transition/discharge plan to the
multidisciplinary team, patient and family. |
10. |
Provides
timely and comprehensive documentation of interactions with patient and/or
families and all transition/discharge planning activities and progress
according to departmental policy. |
11. |
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. |
12. |
Assists
patient/families with completion of medical power of attorney, health care
surrogate, and advanced directives |
13. |
Provides
intervention in child/adult/elder abuse/neglect, domestic violence,
guardianship (temporary/permanent), foster care, adoption, mental health
placement ,child protection or sexual assault |
14. |
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 |
15. |
Uses quality
screens in the electronic record to identify potential issues including but
not limited to- avoidable delays and readmissions |
16. |
Educates
hospital staff and physicians to payer regulations and managed care
principals to prevent denials |
17. |
Fosters the
integration of staff and/or students into the healthcare team |
18. |
Exhibits
professional behavior on a consistent basis |
19. |
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: |
|
1. |
Possesses
excellent interpersonal communication and negotiation skills in interactions
with patients, families, physicians, and health care team colleagues |
2. |
Ability to work
with people of all social, economic, and cultural backgrounds and be
flexible, open minded, and adaptable to change |
3. |
Capable
of independent judgment and action regarding psychosocial needs of patients. |
Date Reviewed/Revised: October 2019 |