Medical Social Worker

Responsibilities Provides coordinated care in the home to patients/clients of all age groups and performs psychosocial assessments, analysis, counseling, and referrals to meet the needs of the patient/client and family. Participates in the coordination of care. Performs ongoing clinical assessment of home health patients/clients to identify psychosocial, financial, environmental, and community resource needs as evidenced by the Plan of Care (POC), documentation, clinical records, case conferences, and community resource referrals. Develops and evaluates the plan of care in partnership with the patient/client, representative (if any), and caregiver(s). Accepts clinical assignments that are consistent with education and competence to meet the needs of the patients/clients. Provides services that are ordered by the physician as indicated in the Plan of Care, including patient/client, caregiver, and family counseling, and patient/client and caregiver education. Prepares clinical notes. Uses effective interpersonal relations and communication skills; facilitates the use of these skills by other team members to achieve desirable outcomes. Communicates with all physicians involved in the Plan of Care and other healthcare practitioners related to the current Plan of Care. Meets mandatory continuing education requirements of the Agency and licensing board. Demonstrates commitment, professional growth, and competency by maintaining a working knowledge of public and private eligibility standards and requirements. Promotes the Agency philosophy and administrative policies to ensure quality of care. Collaborates with the interdisciplinary team to promote coordination of patient/client care. Meets productivity standards as outlined by the agency. Meets or exceeds agency documentation standards timely and efficiently. Participates in the Agency’s QAPI program. Participates in the Agency sponsored in-service trainings. Provides supervision of social work assistants, if applicable. #J-18808-Ljbffr