Social Worker II AHWFB

Provides psychosocial assessment, care coordination, discharge planning, advocacy, and resource management for patients and families across the continuum of care. Collaborates with the interdisciplinary team to support patient progression, transition planning, and access to community resources.

Education / Experience

• Master's degree in Social Work from a school accredited by the Council on Social Work Education (CSWE)

Licensure, Certification, and/or Registration

• Clinical licensure (or provisional status) preferred
• Accredited Case Manager certification (ACM-SW) preferred

Essential Functions

• Identify patients who would benefit from Case Management interventions through an initial screening assessment of discharge needs.
• Assess relevant information by interviewing patients and families and evaluating patient needs.
• Complete psychosocial assessments in accordance with departmental and professional standards to identify emotional, social, and environmental needs related to diagnosis, illness, treatment, and life situations.
• Develop and implement psychosocial treatment plans utilizing appropriate social work interventions, including:
  • Crisis intervention
  • Individual therapy
  • Family therapy
  • Grief and bereavement counseling
• Initiate appropriate internal and external referrals based on individual patient needs.
• Maintain current knowledge of applicable federal, state, and local regulations.
• Advocate for patients' unmet needs.
• Collaborate with the multidisciplinary team to develop discharge plans and support progression through the continuum of care.
• Maintain knowledge of payer and reimbursement practices affecting patient care plans.
• Coordinate patient and family care conferences as needed.
• Identify barriers to effective patient care management and implement strategies to address them.
• Document patient interactions and interventions in the Electronic Medical Record (EMR) according to departmental standards.
• Guide patients and families through evaluation of post-discharge care options.

Skills / Qualifications

• Demonstrated competence in age-appropriate and developmentally appropriate care
• Ability to establish positive working relationships and reduce workplace conflict
• Strong organizational skills with the ability to work in a fast-paced environment and manage multiple interruptions
• Adaptability and willingness to embrace change in a rapidly evolving healthcare environment
• Social work experience in a healthcare setting preferred