Social Worker MSW

Summary

Responsible for the delivery of social work services inclusive of all patient populations across the continuum of care for MyMichigan Health System. Services will be in collaboration with other members of the healthcare team. 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. Communicates teamwork, caring, and compassion with all internal and external healthcare team members.

Responsibilities

• (25%)
• Complete and document a standard social work psycho-social-spiritual assessment to: Eliminate barriers to treatment Increase patient/family satisfaction Improve appropriate utilization of resources (25%)
• 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. (25%)
• 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. (25%)
• 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. OTHER DUTIES AND RESPONSIBILITIES: 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 patient’s 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. Identify the need for and conduct family meetings, with or without the physician, that result in understanding, comfort, decision-making, and other important outcomes. Identify and provide for learning needs of patients, families, and healthcare team. Participate in the department’s performance improvement/CQI processes. Attend and actively participate in staff meetings; maintain positive working relationships with team and knowledge about community agencies and services. Assume responsibility for professional development and educational requirements for maintenance of professional licensure. MidMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft® Windows. An employee may be required to participate in further learning opportunities offered by MidMichigan Health.