Company
Healthcare
SOCIALWORKER
Neural analysis suggests this role is
optimal for Mid+ candidates.
“SOCIAL WORKER. Skills: Social work, Participant advocacy, Care coordination. Provide social work services. Advocate for participants”
What You'll Achieve.
Ensure highest satisfaction; Meet participant-centered goals
Industry & Context.
Problem resolution
Physical lifting up to 50 pounds, Maneuver stairs, Climb stairs, Walk between sites, Agility, Fine motor skills, Visual assessment, Audio hearing, Good decision-making, Cognitive ability
What They're Looking For.
Must Have
M.S.W. from accredited college, One year experience in health care, One year experience with frail/elderly population, Active NY State Social Work license, Legally authorized to practice in NY State, Medically cleared for communicable diseases, Immunizations up-to-date
Nice to Have
Experience in home care, Experience in field work, Regular access to car for field visits, Chinese Bilingual (Mandarin, Cantonese, Fuzhounese)
What You'll Do.
Provide social work services
Advocate for participants
Assess participant needs
Collaborate with teams
Evaluate participant progress
Plan for participants
Provide concrete services
Provide adjustment support
Provide crisis intervention
Provide end of life care
Assess psychosocial conduct
Evaluate mental status
Participate in discharge planning
Enlist community agency services
Educate on community services
Assist with referrals
Coordinate community services
Complete related documents
Ensure communication during hospitalization
Coordinate care post hospitalization
Report communication with facilities
Document communication with facilities
Provide social work consultation
Educate on treatment options
Coordinate palliative care
Coordinate end of life care
Arrange bereavement assistance
Arrange supportive counseling
Arrange behavioral health services
Provide caregiver support
Complete biopsychosocial assessments
Complete cognitive emotional assessments
Complete HCP document
Facilitate advance directives completion
Assure Care Plan psychosocial goals applied
Utilize EMR for assessments
Complete documentation timely
Complete documentation accurately
Resolve social problems
Resolve financial problems
Resolve psychological problems
Ensure care coordination
Ensure service follow-through
Integrate best practices
Collaborate with professional personnel
Facilitate psycho-educational presentations
Participate in IDT meetings
Attend care plan meetings
Participate in care plan meetings
Identify social work concerns
Document social work concerns
Present social work concerns
Present social work interventions
Present social work recommendations
Ensure social work interventions applied
Meet participant-centered goals
Participate in continuing education
Participate in professional training
Attend approved seminars
Attend approved workshops
Participate in peer supervision
Participate in individual conferences
Represent Social Work department
Represent CenterLight Healthcare
Act within scope of authority
Meet standardized competencies
Perform other duties as assigned
How You'll Work.
Team & Collaboration
Interdisciplinary Care Team; Community agencies; Acute care institutions; Skilled nursing facilities
Communication Scope
Psycho-educational presentations
Full Job Description
**JOB PURPOSE:** Under the direction of the Social Work Manager, the Social Worker will provide social work services including: advocating, assessing, assisting, collaborating, educating, evaluating, implementing and planning for participants in various aspects of the participant's life including but not limited to psychological, psychosocial, financial, environmental, and interpersonal matters. Social work engagement takes place in various settings including but not limited to the participant's home, PACE site, community settings (hospital, SNF, ALF, etc.). The Social Worker will serve as a conduit among the participant/authorized representative, the Interdisciplinary Care Team and other community agencies (hospital, SNF, ALF, APS etc.) to ensure the highest level of satisfaction throughout the PACE lifecycle. The Social Worker will provide support to the PACE participant, including but not limited to concrete services, adjustment to illness/disability/treatment, crisis intervention, and end of life care. The Social Worker will assess and evaluate psychosocial functioning; conduct mental status assessments; participate in discharge planning; and enlist collateral community agencies’ services as applicable. **JOB RESPONSIBILITIES:** * Provide ongoing social work services to participants and their authorized representatives to help them understand and follow care delivery recommendations; to assist them with personal and environmental challenges which predispose toward illness or interfere with obtaining maximum benefit from the PACE program. * Educate participants and their authorized representatives in understanding and using community, health and public services and benefits which help them remain safely in the community (SNAP, SC/DRIE, Medicaid, Medicare, housing, etc.) and assist with making referrals, coordinating services and completing related documents as needed. * Ensure timely and appropriate communication and coordination of care during/post hospitalizati
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