Palliative Care Social Worker

Palliative Care Social Worker

The Division of Palliative Care at Jefferson Health seeks a compassionate, collaborative, and experienced Palliative Care Social Worker to join our growing interdisciplinary team serving patients and families at Thomas Jefferson University Hospital and Methodist Hospital Division. The Social Worker will work alongside palliative care physicians, nurse practitioners, chaplains, nurses, and other healthcare professionals to provide comprehensive psychosocial support to patients facing serious illness and their caregivers. This care will occur within the hospital, in the ambulatory clinics and in patient homes. This position plays a critical role in addressing the emotional, social, practical, financial, and advance care planning needs of patients across inpatient and outpatient settings. The ideal candidate will have experience working with patients with serious illness, complex medical conditions, advanced chronic disease, or end-of-life care needs and will thrive in a highly collaborative, team-based environment.

Provides social work services, assesses and enhances the patient's/family's/significant other's ability to cope with physical, emotional and environmental problems related to illness/convalescence and discharge plan. Works collaboratively with the multidisciplinary healthcare team to establish a discharge plan for the patient.

Job Duties

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Conducts psychosocial assessment/reassignment of patients/significant others relating to the social, emotional and cognitive capabilities of patients in relationship to their illness and health maintenance needs.
• Develops and implements a plan of intervention that addresses identified needs related to needs/problems identified during assessment. Collaborated with the multidisciplinary team to ensure appropriate discharge planning. Provides counseling for patient/family/significant others to assist with coping with new diagnoses, chronic illness and palliative or terminal care
• Advocates on behalf of the patients/families to enable them to obtain necessary services.

Minimum Qualifications

• Master's Degree Graduate from an accredited Masters of Social Work program required.
• 2 years hospital based social work experience.
• Knowledge of: Medical terminology and disease process; Community resources; Insurance regulations and requirements
• Skill in: Work with multidisciplinary teams, outside resources, patients/families/significant others
• Ability to: Establish an appropriate plan to safely discharge patients to the next level of care
• Serves as a resource and provides counseling and intervention related to treatment decisions and end of life care issues.
• Refers patient/significant other to community based services/resources to meet patient's continuum of care needs.
• Coordinates team and/or family conferences when necessary to facilitate patient's care progression.
• Provides psychosocial counseling and crisis interventions to patients/significant others with needs. Provides interventions in cases involving child abuse/neglect, domestic violence, elder abuse and institutional abuse. Provides intervention in cases involving guardianship, foster care, adoption, psychiatric assessment and placement, Advance Directives (Center City), trauma and substance abuse.
• Facilitates completion of all placement related documentation in nursing home grants, applications, etc. Completes referrals to options programs where appropriate.
• Documents in accordance with hospital and departmental requirements.
• Works with Case Managers in providing discharge planning services per departmental policies and procedures in collaboration with the multidisciplinary team and patient/family.
• Identifies patients and locates family and/or next of kin.
• Educates patients/significant others on the process for obtaining health insurance. Provides appropriate documents/information to apply for welfare insurance.
• When necessary, initiates medical assistance application in a timely manner (Center City) or ensure medical assistance application has been initiated by identified external agencies (excludes Center City). Follows up with identified external service regarding application.
• Provides psychosocial assessment and intervention as well as documents in the electronic medical record updates throughout patient's hospitalization, discharge planning process and relevant post-acute care
• Supervises field placement of MSW students.
• When appropriate, refer case to the Placement Official Social Worker to assist in obtaining placement for the patient's discharge (Center City and Abington/Lansdale).
• Precept and mentor new staff members to their role and department.
• Facilitates and coordinates discharge plans for patient identified to leave on the weekend, including homecare/hospice services; transportation; post-acute facility placements
• Perform assessments and develops relevant interventions specifically for trauma patients (Abington)
• Obtains relevant post-acute authorizations
• Manages Livanta appeal determinations and if necessary address alternate discharge plans
• Provides updates to post-acute facility liaisons regarding possible weekend discharges
• Reviews discharge orders to determine which patients can be transitioned to the next level of care that day (JNE)
• Assist with completing relevant 302 paperwork, when necessary
• Documents updates for the week day staff per department procedures.

Additional Qualifications Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.