Position summary:Responsible and accountable for the management of all social services needs and discharge planning for the Medical Surgical and Swingbed patients. Also available for consultations with other hospital departments.

Role qualifications:

Education:

Graduate of accredited school of social work, nursing or related field

Experience:Experience in healthcare field preferred, but not required

Licenses/Certificate:Additional training and/or licensure preferred, but not required

Position responsibilities:

• Patient assessment
• Supportive counseling to patient and families
• Discharge planning
• Collaborating with hospital staff, physicians and outside agencies
• Acceptance and coordination of skilled referrals from other facilities
• Attending Care Plan and other meetings as designated.
• Documentation on all patient contacts and referrals
• Review Department Manual, Quality Improvement and monthly audit
• Computer knowledge
• Available for consultations with other hospital departments
• Making arrangements for obtaining needed adaptive equipment, clothing, and personal items
• Maintaining contact with family (with residents permission) to report on changes in health, current goals, discharge planning, and encouragement to participate in care planning
• Assisting staff to inform residents and those they designate about the residents health status and health care choices
• Making referrals and obtaining services from outside entities (e.g., applying for pensions, referrals to lawyers, referrals to funeral homes for preplanning arrangements)
• Discharge planning services (e.g., helping to place a resident on a waiting list for community congregate living, arranging intake for home care services for residents returning home, assisting with transfer arrangements to other facilities. Setting up durable medical equipment of pt. choice)
• Providing or arranging provision of needed counseling services
• Assisting residents to determine how they would like to make decisions about their health care, and whether or not they would like anyone else to be involved in those decisions
• Finding options that meet the physical and emotional needs of each resident
• Meeting the needs of residents who are grieving
• Assisting residents with dental/denture care, podiatric care; eye care; hearing services, and obtaining equipment for mobility or assistive eating devices. (Where Medicaid State Plan does not cover needed services)

Essential skills and experience:

• Interviewing
• Assessment
• Ability to organize and manage multiple priorities
• Knowledge of community resources including State and Federal
• Maintain confidentiality
• Basic computer skills including excel

Reporting to this position: No direct reports