POSITIONAL SUMMARY:
The Medical Social Worker (MSW) plays a crucial role in providing comprehensive medical social services to home health patients and their families within the comfort of the patient's residence. Under the guidance of the physician and in collaboration with the interdisciplinary team, the MSW assesses various social, emotional, and environmental factors impacting the patient's health status and their ability to safely remain at home. This professional not only educates and supports patients and caregivers but also connects them to vital community resources and entitlement programs, empowering families to understand their options and effectively cope with disease progression.
DUTIES AND RESPONSIBILITIES:
The responsibilities of this position encompass, but are not limited to:
- Conducting initial and ongoing psychosocial assessments to evaluate patients' social, emotional, and environmental needs, including caregiver capacity and home safety, thereby supporting the overall plan of care. The MSW will observe and document any changes in patient status and their responses to interventions.
- Providing essential social work support, education, and resource guidance to patients and caregivers, focusing on coping mechanisms for illness, understanding disease progression, and adjusting to evolving care needs.
- Collaborating effectively with physicians, nurses, therapists, and other members of the interdisciplinary team to create and regularly update tailored plans of care, and actively participating in care conferences as required.
- Identifying and connecting patients and families to community resources, entitlement programs, and benefits, such as state Medicaid programs, while maximizing the advantages of community-based initiatives.
- Supporting patients and families through home safety evaluations and coordinating necessary modifications, as well as facilitating care transitions and discharge planning.
- Delivering services directly in the patient's residence based on assessed needs, while ensuring timely completion of visit documentation and case files in accordance with Medicare Conditions of Participation, relevant state regulations, payer requirements, and company procedures.
MINIMUM QUALIFICATIONS:
- Active social work license in good standing in the state of practice (Arizona LMSW or LCSW; California LCSW), as mandated by applicable state social work licensing laws and regulations.
- Master's or doctoral degree in social work from a program accredited by the Council on Social Work Education (CSWE), in compliance with 42 CFR §484.115(m).
- A minimum of one year of social work experience in a healthcare setting, as specified by 42 CFR §484.115(m).
- Proficient understanding of community resources, entitlement programs, and the specific needs of older adults and chronically ill patients, including those affected by Alzheimer's disease and related dementias, along with their impact on family dynamics. Comfort and competence in working with patients in their home environments is essential.
- Possession of a valid driver's license, reliable transportation, and current auto insurance for travel to patient homes.
- Successful completion of a background check and obtaining required health clearances/immunizations as per company policy and state regulations.