Department: Healthcare Quality
Employment Status: Part Time
The Post-Acute Care Transitions (PACT) Program is a 3-year demonstration project funded by the Center for Medicare and Medicaid Innovation aimed at improving care transitions by utilizing nurses and pharmacists in new ways.
Job Summary: Under clinical supervision, responsible for psychosocial screening, assessment, diagnosis, treatment, and follow-up for patients and families in assigned patient population. Collaborates with physicians, nurses, internal and external case managers, community agencies, and other health care professionals to implement safe and effective patient care.
Reports to the social work manager / manager of clinical service area
Department Specific Job Responsibilities:
Consults with the Post-Acute Care Transitions (PACT) team to determine what resources would optimally meet patients' and families' needs. Uses extensive knowledge of local and state resources to recommend multifaceted service plans to meet patients' complex needs.
The social work position will manage and support a new Care Conference model, ensuring that the meetings happen on a regular basis for appropriate patients. He or she will check in with newly admitted patients and introduce My Care Conference as an opportunity for patients and family members to meet with their Care Team in a setting optimized for open discussion and patient empowerment.
The social worker will also identify potential times for the Care Conference, and coordinate schedules with the patient, family members and providers. Most importantly, he or she will serve as a 'coach' who assists the patient in preparing for the conference, and then leads the session to ensure the patient achieves his/her objectives.
Funded through a 3-year endowment, the position will also help to evaluate the impact of the Care Conference program and potentially assist in identifying ways to expand the program to a larger population. Essential Responsibilities:
Provides clinical services to patients and families that address personal and environmental issues in order to maximize emotional, social, and physical well being and the appropriate and efficient use of health care resources.
Screens and triages patients who request service, are referred, or meet screening criteria for identifying patients' needs. Conducts psychosocial assessments and provides services as indicated. Partners with the multidisciplinary team to facilitate continuity of care planning.
Provides counseling and psychotherapeutic services appropriate to setting. Provides timely and appropriate communication and documentation in medical record. Provides consultation and education regarding psycho-social issues affecting patient care. Advises and addresses ethical and risk management issues.
Presents and/or discusses clinical work in formal and informal settings and seminars. Participates in CQI efforts and in After Hours Program as needed. Partners with advanced staff on research. Presents clinical material and theory at teaching conferences and seminars.
Participates in clinical supervision as appropriate to level of professional development. Serves as a content resource for multidisciplinary staff; and mentor/trainer to less experienced staff. Encourages an environment of idea sharing and feedback. Seeks opportunities and implements goals for own professional development. Required Qualifications:
Master's degree required in Social Work.
License required: Lic Clinical Social Worker
0-1 years related work experience required.
If license pending, will work under the direct clinical supervision and have all notes co-signed by a licensed social worker. Expected to obtain Massachusetts license within 3-6 months.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access. Preferred Qualifications:
Health care and/or human service experience. Competencies:
Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
Team Work: Ability to act as a team leader for small projects or work groups, creating a collaborative and respectful team environment and improving workflows. Results may impact the operations of one or more departments.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations. Age based Competencies:
Employees in this job must be competent to provide patient care to the following age groups: Neonatal: Birth to 6 months, Youth: 6 months to 16 years, Young adult: 16-30 years, Middle Age: 30 - 60 years, Elderly: 60 -.
Physical Nature of the Job:
Light work: Exerting up to 20 pounds of force frequently to move objects. Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move through out the hospital campus
Beth Israel Deaconess Medical Center (BIDMC) is a patient care, teaching and research affiliate of Harvard Medical School, and currently...