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Overview

The Social Worker is responsible to identify and create action plans to meet the social, psychosocial, environmental and/or discharge planning needs of patients and families. The social worker assists patients and families in maximizing the utilization of health care and community resources in order to achieve their optimal level of wellness

This is a 1.0 full-time Monday through Friday 8am-4:30pm position, with every 6th Sunday weekend component. This is an on-site position that would primarily be based at M Health Fairview's Acute Rehabilitation Unit.

The position is posted as an MSW position but is open to BSW, MSW and LICSW candidates that have at least two years of experience working in a healthcare setting. We are seeking a highly skilled social worker with experience working in the medical field on complex high acuity discharge planning. Ideally this candidate would be able to work autonomously, think outside the box and offer creative solutions for complex patients that have multiple barriers to discharge from the hospital. This position would serve as a liaison for our partnered skilled nursing facilities to facilitate discharges. This position would review cases and identify patients that would be appropriate candidates for these complex transitional care unit beds. This position would also review complex case escalations at the above identified hospitals and help unit social workers with progression of care and discharge planning.

Responsibilities Job Description

• Plans and implements treatment and transition care plans based upon a psychosocial assessment that is integrated into an interdisciplinary care plan.

• Provides a range of social work interventions that include, case management, counseling, crisis intervention, and advocacy in assisting patients and families reach their goals. Identifies and recognizes rapidly changing situations and quickly intervenes to prevent or resolve the emotional crisis.,

• Arranges, mobilizes, utilizes, and may coordinate a comprehensive range of community resources which most effectively meet the identified patient and family needs.

• Takes leadership role in facilitation of interdisciplinary communication as it relates to patients and families experiencing complex psychosocial issues.

• Formally and informally educates patient/family and health care team members regarding the social work role, pertinent patient care issues, and population specific information.

• Serves as a preceptor or field instructor for social work graduate and undergraduate training as appropriate to their skills related to a range of psychosocial issues and interventions.

• Serves as patient advocate and liaison with physicians, families and community to ensure continuity of care.

• Documents psychosocial assessment, progress notes, care plans and discharge/transition plan in the electronic medical record.

• Identifies and participates in Quality Improvement, research and program evaluation initiatives that focus on improving health care services Demonstrates knowledge and compliance with MHealth Fairview and Social Work practice, ethics and standards.

• Complies with the legal and regulatory law including mandated reporting requirements.

• Serves as a liaison between our partner skilled nursing facilities and hospitals across our system

• Reviews complex cases and provides recommendations on next steps

• Assists with follow-up needed to progress complex case escalations

• Travels to hospitals and partnered skilled nursing facilities across our system

Qualifications

Required :

Bachelor's degree in Social Work with medical experience

Current Minnesota Social Work Licensure at the BSW level

2 years' experience in a health care setting

Preferred :

Master's Degree in Social Work

Current Minnesota Social Work Licensure at the LGSW, LISW or LICSW level

3-5 years’ experience in a health care setting; ability to analyze, intervene and evaluate a range of psychosocial theory and methods in practice with clients; and demonstrated knowledge of community and economic resources.

EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status