Jupiter Medical Center
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Social Worker MSW Full Time
at Jupiter Medical Center
Under the direction of either the Director of Case Management and supervision of the LCSW Case Manager, the social worker will provide accurate information to DME, SNF, LTAC, HHC agencies and other providers along the patients' continuum of care. Teamwork is essential to implement the discharge plan with compliance of all regulatory agencies (ACHA, CMS, The Joint Commission, etc.). The MSW Social worker oversees coordinating patient discharge evaluations. They craft a comprehensive discharge plan including where the patient is going, how the patient will get there and who the patient will see in the next phase of their treatment.
The Social Worker reviews and discusses the plan with the patient, family, representative and multidisciplinary care team to ensure all parties understand and agrees to the transition plan. Document accordingly in medical record. The Social Worker also coordinates planning an evaluation among various disciplines responsible for patient care.
The MSW prepared social worker is responsible to coordinating family meetings when requested by the physician, family or nursing team in an effort to provide a smooth transition to the next level of care and provide transparency in the transition plan.
When identified during the initial transition planning assessment by either the primary RN Case Manager and/or social worker the MSW social worker may provide psychosocial interventions and document accordingly.
After the patient is discharged from the hospital, the Social Worker remains available to answer any questions or provide new referrals if necessary. Knowledge of social and physical factors that affect functional status at discharge is essential in delivering a comprehensive and successful discharge plan.
The Social Worker has a broad knowledge of local and federal community resources to help assist in safe discharges. Maintaining a complete and accurate file of appropriate community-based services, supports, and facilities where the patient can be transferred or referred. These services, supports, and facilities include Nursing Facility (NF) or Skilled Nursing Facility (SNF) care, long-term acute care, rehabilitation services, Home Health care, Hospice, or other appropriate care.
- Master's degree in social work required
- ACM Social Worker certification preferred
- 2 years acute care experience, SNF, or home health experience. Knowledge of community resources, general information of the healthcare system. Highly organized, empathetic, and capable of multitasking in a high-stressed environment. High ability to set priorities, conflict management, and time management. Pleasant personality and phone etiquette. Excellent verbal and written communication skills. High skill level in computer and other peripheral systems. Customer service and negotiation skills are a must.
- Responsible for assuring all state and federal documents are reviewed and completed timely and accurately.
- Proficient assessment skills in identifying psychosocial needs, barriers to transition planning and home needs.
- Ability to handle difficult situations in a way that promotes best outcomes for the patient and fiscally responsible for the patient and organization.
- Effective time management skills.
- Understanding of state and federal documentation requirements and compliance to these regulations.
- Experience providing psychosocial interventions and therapy to acute ill patients and/or their family.