Medical Social Worker (BSW)

Job Description

Job Description

  Job Opportunity: Hospice Medical Social Worker – BSW

Position: Medical Social Worker
Department: Home Health and Hospice
Supervisor: Manager of Support Services

Job Summary:
We are seeking a compassionate and skilled Medical Social Worker to join our team. This professional role is responsible for providing social work services to patients and families receiving home health or  hospice care. This role focuses on psychosocial assessment, care planning, counseling, resource coordination, end of life planning and advocacy to support patients’ emotional, social, and environmental needs. The Social Worker collaborates with the interdisciplinary team to promote quality of life, patient autonomy, and continuity of care while adhering to regulatory, ethical, and confidentiality standards. 

Key Responsibilities

Social Work Services:
Patient & Family Assessment:

• Conduct comprehensive psychosocial assessments to evaluate emotional, social, financial, cultural, and environmental factors affecting patient care. 
• Assess coping abilities, support systems, caregiver needs, safety concerns, and community resource needs. 
• Identify risk factors such as caregiver strain, mental health concerns, abuse, neglect, or financial hardship, and escalate per agency policy. 

Care Planning & Interdisciplinary Collaboration:

• Develop and document individualized social work care plans aligned with patient goals and clinical needs. 
• Participate as an active member of the interdisciplinary team (IDT), including physicians, nurses, therapists, aides, chaplains, and volunteers. 
• Provide regular updates to the team regarding psychosocial needs, progress, and changes in patient or family status. 

Counseling & Emotional Support:

• Provide counseling, education, and emotional support to patients and families related to illness, end‑of‑life issues, grief, adjustment, and coping. 
• Support patients and families with advance care planning, decision‑making, and goal clarification. 
• Provide crisis intervention services as needed. 

Resource Coordination & Advocacy:  

• Assist patients and families in accessing community resources, including financial assistance, transportation, housing, food, end of life and long‑term care planning, and caregiver support services. 
• Educate patients and families on available benefits, community programs, and eligibility requirements. 
• Advocate for patient rights and needs within the healthcare system and community. 

Discharge & Transition Planning:  

• Collaborate with the interdisciplinary team to support discharge planning and transitions of care. 
• Coordinate services and resources to ensure continuity and safety following discharge or service changes. 
• Support families through hospice transitions and bereavement planning as applicable. 

Documentation & Compliance:  

• Complete timely, accurate, and comprehensive documentation in the electronic health record (EHR) in accordance with agency policy and payer requirements. 
• Ensure documentation meets Medicare Conditions of Participation and hospice/home health regulatory standards. 
• Maintain confidentiality and comply with HIPAA and professional ethics at all times. 

Education & Support:

• Provide education to patients, families, and caregivers related to disease progression, psychosocial adjustment, and available supports. 
• Offer guidance to staff regarding psychosocial dynamics affecting patient care. 
• Support bereavement services and follow‑up per hospice policy, when applicable. 

Additional Responsibilities:

• Participate in team meetings, training, and quality improvement activities. 
• Perform other duties as assigned to support agency operations and patient care. 

Knowledge, Skills, and Abilities:

• Knowledge of psychosocial aspects of illness, aging, disability, and end‑of‑life care 
• Understanding of Medicare home health and hospice regulations  
• Strong assessment, counseling, and communication skills 
• Ability to work independently and as part of an interdisciplinary team 
• Excellent documentation and time‑management skills 
• Cultural sensitivity and ability to work with diverse populations 
• Compassion, professionalism, and ethical judgment

 
Physical Requirements and Working Conditions:  

• Ability to travel to patient homes and community sites  
• Ability to sit, stand, walk, and drive for extended periods  
• Ability to lift up to 25 pounds occasionally 

Education and Other Requirements:  

• A Hospice/Home Health Social Worker must at least meet one of the following options:  
• Have a baccalaureate degree in social work (BSW) from a school of social work accredited by the CSWE, and one year of experience in a health care setting and be supervised by a MSW from a school of social work accredited by the CSWE and who has one year of experience in a health care setting.  
• Have a baccalaureate degree in psychology, sociology or other field related to social work, and at least one year of social work experience in a health care setting and be supervised by a MSW from a school of social work accredited by the CSWE and who has one year of experience in a health care setting. 
• CPR certification  
• A valid driver’s license, reliable transportation, proof of auto insurance with acceptable driving history is required. 

Core Values:
Integrity: We build trust through responsible actions and honest relationships.
Respect: We value the potential in each individual and treat all with dignity and compassion.
Teamwork: We work together without barriers and encourage creativity through empowerment.
Appreciation: We foster a culture that recognizes and rewards the contributions of each employee.

• REQUIRED CLEARANCES: The following are required at time of hire: PA State Police Criminal Background Check, PA Child Abuse Clearance and FBI Fingerprint Criminal Background Check.  Positions providing direct patient care will also be required every 5 years after date of hire.   
• The job description is only a summary of the typical functions of the job, not an exhaustive or comprehensive list of all possible job responsibilities, tasks, and duties.  The responsibilities, tasks, and duties of the jobholder might differ from those outlined in the job description and other duties as assigned might be part of the job.  
• This job description does not constitute an employment contract; the employment relationship between VNA of Hanover and Spring Grove and the employee is an at-will relationship.  
• This position is considered a safety sensitive position, which means the employee’s job performance can affect the safety of the employee and others. Job performance under the influence of alcohol or drugs could lead to physical injury or death to the employee, other employees, or members of the public at large. Therefore, employees must be able to perform the job responsibilities without causing a threat to co-workers, to the workplace, or to the public at large.  
• We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, hair type, texture, and protective hairstyles like locs, braids, and twists, or any other status or any other characteristic protected by law. 

Why Join Our Team?
You’ll have the opportunity to make a meaningful impact by supporting patients and families during a challenging time. If you are compassionate, resourceful, and eager to be part of a collaborative team, we’d love to hear from you.