Social Worker — Living with Assistance

MISSION STATEMENT: Empowered by God's love, rooted in the Gospel of Jesus, faithful to the vision of one sacred Earth community, we live and work to bring all into union with God and one another. POSITION SUMMARY: The Social Worker provides person-centered, mission-aligned services to Sisters living in the three Living with Assistance (LWA) communities: the Convent in Brentwood, Sacred Heart in Hempstead, and Stella Maris in Far Rockaway. The role promotes dignity, autonomy, safety, and the least restrictive living environment appropriate to each sister's needs. The Social Worker coordinates psychosocial care, benefits, long-term planning, Medicaid and Managed Long-Term Care (MLTC), home care, and transitions across hospitals, rehabilitation facilities, assisted living, skilled nursing, hospice, and community settings. The position collaborates with Sisters, Health Care Professionals (HCPs), nurses, Community Life Coordinators (CLCs), leadership, authorized representatives, providers, health plans, and government and community agencies. Preferred QUALIFICATIONS: Experience serving religious communities or working in a faith-based, mission-driven organization. Knowledge of New York State and local aging, disability, behavioral health, housing, transportation, and long-term care resources. Experience with health care proxies, powers of attorney, advance care planning, hospice, palliative care, and skilled nursing placement. Minimum Qualifications Master's degree in social work from a program accredited by the Council on Social Work Education. Current New York State LMSW or LCSW license in good standing. Knowledge of Medicaid eligibility or renewals, Medicare and public benefits, MLTC, home care coordination, and hospital or rehabilitation discharge planning. Strong assessment, care planning, advocacy, crisis intervention, documentation, organization, and professional communication skills. Proficiency with electronic health records, Microsoft Office or Google Workspace, benefit portals, and case-management systems. Valid driver's license and reliable transportation for regular travel among sites and community locations. ESSENTIAL DUTIES & RESPONSIBILITIES - Includes, but is not limited to, the following: Completes comprehensive psychosocial assessments and reassessments; identifies strengths, preferences, support systems, functional needs, cognitive or behavioral concerns, environmental risks, and barriers to care; and develop individualized social work plans with the sister and interdisciplinary team. Provides brief supportive counseling, crisis intervention, adjustment and grief support, and referrals to behavioral health or specialized services. Monitors changes in social, functional, financial, or environmental circumstances and escalates significant concerns promptly. Promotes informed choice, self-determination, privacy, dignity, cultural humility, and respect for each Sister's spiritual life and vowed commitments. Assesses eligibility for public and private benefits and coordinates applications, renewals, recertifications, documentation, and follow-up for Medicaid, Medicare, Social Security, Supplemental Security Income, prescription coverage, transportation, and other applicable benefits. Tracks Medicaid applications and annual renewals, responds to notices, maintains benefits calendar, and works with Sisters, authorized representatives, Finance, providers, plans, and agencies to resolve coverage interruptions, spend-down or surplus issues, authorization barriers, and billing concerns. Facilitates long-term planning based on each sister's preferences, clinical needs, finances, benefits, supports, and desired living arrangement. Educates Sisters and representatives about MLTC, home and community-based services, personal care, consumer-directed services, certified home health care, adult day services, respite, hospice, assisted living, and skilled nursing care. Coordinates MLTC assessments, plan selection, enrollment, authorizations, service planning, and start of care. Arrange and monitors home care and work with agencies and clinical staff to address staffing, scheduling, service hours, quality, safety, and continuity concerns. Supports advance care planning and helps keep health care proxies, Medical Orders for Life- Sustaining Treatment (MOLST), advance directives, emergency contacts, and related documents current and accessible in accordance with organizational policy and each sister's wishes. Tracks emergency department, hospital, rehabilitation, and skilled nursing admissions; communicates with the sister, team, facility staff, and authorized representatives; participates in discharge planning; and evaluates proposed plans for safety, feasibility, authorization, available supports, and alignment with the sister's preferences. Coordinates post-discharge appointments, medications, transportation, equipment, benefits, home care, and follow-up. Advocates for continuity of care and escalates unsafe, delayed, or incomplete discharge arrangements. Serves as the primary social work resource across the three LWA sites; participates in care conferences, case reviews, team meetings, transition planning; and coordinates medical, psychosocial, spiritual, and practical support with HCPs, RNs, CLCs, house administrators, providers, and leadership. Communicates with families, health care agents, powers of attorney, guardians, attorneys, and other representatives within authorized and confidential boundaries. Advocates with hospitals, health plans, home care agencies, government offices, and community providers to secure timely services and remove barriers. Documents assessments, interventions, referrals, care plans, contacts, authorizations, benefit activity, discharge plans, outcomes, and follow-up promptly. Maintains confidential records, tracks caseload and service outcomes, prepare reports, and follows mandated reporting, incident, emergency, abuse or neglect, and escalation procedures. Identifies service gaps and recommends improvements; participates in quality improvement, policy development, staff education, audits, and Health and Wellness initiatives; and manages competing priorities with timely, equitable follow-up across locations. Maintains a regular presence at all three LWA sites and travels to health care facilities, government offices, and community providers. Responds to urgent psychosocial, benefits, placement, and discharge-planning matters during work hours and participates in after-hours consultation or coverage when assigned. PHYSICAL DEMANDS: The position requires regular travel; movement throughout residential and health care environments; prolonged sitting and computer use; and effective communication in person, by telephone, and electronically. Reasonable accommodation may be provided for qualified individuals who can perform The Position's Essential Functions. The Sisters of Saint Joseph provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics protected veteran status, sexual orientation, gender identity or expression, or any other characteristics protected by federal state or local laws. Compensation for this position is based according to market rate and experience level. This position offers a competitive benefits package including medical, dental, and vision coverage; tuition reimbursement; Flexible Spending Accounts (FSA); a 403(b)-retirement plan; and 14 paid holidays plus paid time off. Compensation for this position is based according to market rate and experience level. #J-18808-Ljbffr Sisters of St. Joseph Brentwood