Social Worker - Transplant Circulatory Support

Overview

The transplant/MCS (Mechanical Circulatory Support) Social Worker assesses psychosocial need and applies comprehensive interventions in order to support the medical treatment plan. The social worker will utilize interventions to enhance patient and family functioning and emotional well-being, and access appropriate and agreed upon services. They are responsible for collaborating and coordinating care to enhance the patient experience from the date of initial referral through transplant/MCS hospitalization and for the duration of the post-transplant/LVAD (Left Ventricular Assist Device) period and the achievement of collaborative goals. They collaboratively develop patient goals, monitor progress, address barriers to goal achievement, and evaluate outcomes of individualized care plans. This role provides training, patient education, referrals to community agencies, multidisciplinary team coordination, guidance, and mentors staff and physicians on management of complex psychosocial patient issues. Due to the needs of patients and families, this position requires flexibility with work hours, including participation in weekend and holiday call schedule, as assigned.

Responsibilities

KEY RESPONSIBILITIES:
1. Evaluate complex patient and family situations which have legal, ethical and psychosocial components.
2. Collaboratively develops patient goals, monitors progress, addresses barriers to goal achievement and evaluates outcomes of individualized care plans.
3. Consider barriers including coping with chronic illness, mental health history/symptoms, cognitive development, adverse developmental events, resistance to treatment, health system impediments, lack of social support and vulnerability.
4. Assessment will reflect interdisciplinary collaboration, which are comprehensive in relation to the patient's age, diagnosis, support systems, and extent of intervention anticipated.
5. The psychosocial evaluation contributes to the overall transplant/MCS evaluation and helps establish specific patient care plans to maximize optimal transplant/MCS recovery and rehabilitation and to ensure to the best possible transplant/MCS outcome, while reducing the impact of known psychosocial risk factors and must include for transplant/MCS:
a. Social History and Support System
b. Understanding/Comprehension of Transplant/MCS Process
c. Self-Management with Medical Treatment (Compliance)
d. Lifestyle Factors
e. Mental and Psychiatric Status/Past and Current
f. Substance Use History
g. Financial/Insurance/Work History
h. Relocation/Lodging
i. Motivation for Transplant/MCS
6. Network proactively with and demonstrate a working knowledge of community resources
7. Demonstrates and applies knowledge of State rules and Federal regulations that ensure safety, quality of life, and protection of patient rights.
8. Recommend consultation requests as appropriate.
9. Engage patient/family in the treatment and decision-making process with respect to patient rights, principles of confidentiality, respect for patient privacy, and right to self-determination.
10. Utilizes crisis intervention, conflict resolution, and mediation to address patient/family concerns.
11. Provide age specific education and information to patient/family, particularly related to coping, community resources and advocacy.
12. Ensure program compliance with established policies and procedures to meet UNOS/OPTN regulatory standards, DNV accreditation, CMS, OSHA and HIPPA guidelines.
13. Document and verbally communicates all assessments, interventions, and clinical services provided to reflect case activity.
14. Monitors and improves quality of services provided to patients/families through participation in quality improvement activities.
15. Participation in transplant/MCS care team conference and selection committee meetings; prepare and present findings and recommendations, as assigned.
16. Active participation in transplant/MCS-related and social work professional organizations.
17. Works with UM staff, physicians, and other members of the interdisciplinary team to prioritize patient for discharge/transitional care needs and intervention of assigned patient population, including pre-certifications.
18. Participates in weekend and holiday call schedule, as assigned.
19. Aids in the development, facilitation and participation of journal clubs specific to the specialty of social work and case management.
20. Acts as an active participant and planning member on specific department committees, conferences and initiatives.
21. Acts as resource to team members, able to be preceptor and mentor to new hires and talent.
KNOWLEDGE, SKILLS, ABILITIES
• Skill and ability to communicate effectively both verbally and in-writing
• Skill and ability to handle multiple priorities and deadlines
• Ability to work as a member of a team
• Skill in decision making, time management, prioritization and organization.
• Ability to collaborate with leadership and the medical staff to develop and maintain a program which provides quality, cost-effective care to transplant patients
• Knowledge and ability to evaluate program needs on an annual basis and as needed to ensure necessary resources are available
• Knowledge and ability to collaborate with healthcare team members to develop and implement policies, procedures, protocols, and pathways to improve patient care
• Knowledge and ability to develop and implement an ongoing staff educational program
• Knowledge and ability to maintain an awareness of current research related to transplant/MCS and incorporate these findings when appropriate
• Knowledge to remain current on transplant/MCS clinical practice and issues through attending meetings, networking with colleagues and reviewing literature

Qualifications

MINIMUM EDUCATION REQUIRED:
Master's degree in Social Work (LMSW)
MINIMUM EXPERIENCE REQUIRED:
Must have a minimum of 2 years social work experience in an acute or post-acute healthcare setting.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
LCSW in the state of Georgia
In lieu of LCSW, Certified Clinical Transplant Social Worker (CCTSW) or Certified Clinical Circulatory Support (CCSW-MCS) may be considered.
ADDITIONAL PREFERRED QUALIFICATIONS:
Previous Transplant/MCS experience

Business Unit : Company Name

Piedmont Atlanta Hospital