Caseworker Home Care

Social Worker
Responsible for the delivery of social work services inclusive of all patient populations across the continuum of care for MyMichigan Health System. The social worker is responsible for assessing the patient's psycho-social-spiritual needs, educating and counseling, along with planning, coordinating and implementing care across the continuum while contributing to patient outcomes and length of stay. Complete and document a standard social work psycho-social-spiritual assessment to:

Provide social work intervention as it relates to hospitalization including crisis management, health care decision-making, illness adjustment, ethical/legal concerns, discharge planning and transitional care needs, child or elder abuse, domestic violence, competency, financial problems, compliance issues, as well as other psychosocial barriers to maximizing health status.
Actively participate in care coordination efforts to successfully identify high-risk factors and respond appropriately so that key information, next steps and avoidable days are captured and documented. Is able to co-lead, with case manager partner, daily care coordination meetings.
Work with the healthcare team, patient, family and/or significant others to continually transition the patient to the appropriate level/place of care. Advocate, mediate and negotiate, with an emphasis on self-determination for the patient system, to formulate a cohesive plan for maintaining the patient's health status, improving social supports, and moving the patient safely into less restrictive, less costly levels of care according to available resources.
Facilitate extended care placements and other facility transfers in coordination with the healthcare team.
Facilitate complex home care arrangements in collaboration with the healthcare team.
Serve as the lead in obtaining financial and other resources for patients and families in need.
Collaborate with the patients physician in competency/capacity determinations, obtaining legal guardianship, involuntary psychiatric admission, adoptions, ethical concerns, etc. Complete and disseminate all necessary legal and clinical documentation as needed for resolution.
Participate in the departments performance improvement/CQI processes.
maintain positive working relationships with team and knowledge about community agencies and services.
MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft Windows. MSW: Masters of Social Work Limited License MSW employees must be actively working to obtain full licensure. These employees must pass licensing exam and work 4,000 hours supervised by a LMSW. Certification in Case Management preferred. Training and experience, and/or demonstrated competency in casework principles, including diagnosis, assessment, crisis intervention, treatment and transition planning; awareness of community resources, public assistance and entitlement programs, ensuring transition to appropriate levels of care; and issues relating to age and stage of development, special needs and cultural patterns of the patient populations being served.
Mandatory Occupational Safety and Health Administration (OSHA) training must be completed annually according to the Exposure Control Plan.
Adherence to the National Association of Social Workers Code of Ethics
Knowledge of medical social work practices, processes as normally acquired through three years' experience working in a hospital (preferred).
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.