Summary of Position:
The Medical Social Worker/Discharge Planner carries an independent case load for coordination of discharge planning activities, and also performs social work interventions on high-risk patients and situations, including newly diagnosed HIV and renal disease, situations involving emotional or physical abuse, drug and alcohol abuse or dependency, homelessness, etc. This position is expected to work closely with the Case Manager on their assigned unit as a team to provide effective and seamless overall care management to all customers.
Assess social, emotional and economic stresses of patients and families, assist with identification of high-risk patients and appropriate resources, coordinate appropriate reporting to legal agencies as needed with respect to abuse.
Provide psychosocial support and crisis intervention to patients and families, act as a patient/family advocate
Coordinate assessment of post-discharge needs, link patients/families to entitlements, community resources and other needed services, coordinate patient placement for patients transitioning to non-acute care settings; i.e., skilled nursing facility; hospice; personal care home, arrange for services necessary to facilitate discharge from acute-care setting
Act as facilitator and coordinator to the interdisciplinary healthcare team with patients and families.
Work with Case Manager to provide seamless overall case management services to all customers, including patients, families, physicians, nursing, quality improvement team, etc.
Staff member provides patient care, treatment, and services within the scope of their license, certification, registration, and/or assessed competencies. Practice will be in accordance with laws and regulations.
Masters degree in Social Work or related field preferred. Professional licensure preferred. Previous social work, discharge planning or equivalent experience in a hospital setting preferred.
Direct to Lead Social Worker, mentoring from Senior Medical Social Worker
Degree of Supervision Given to others:
Direct to Social Work interns
DeKalb Medical - 19 months ago