Bilingual Medical Social Worker MSW

What Youll Do

Position Summary

TheSenior Guiasystematically intervenes to provide clinical social work and complex case management to patients and their families who have complex psychosocial needs require assistance with eligibility determination for social programs and funding sources and qualify for community assistance from a variety of special funds and agencies. This position assesses the patients plan of care and develops implements monitors and documents the utilization of resources internally and externally and progress of the patient through the continuum of care. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This role participates in an interdisciplinary team (including Physicians Case Managers Staff Nurses and other members of the care team) to provide services for high risk patients and ensure that psychosocial needs are attended to and treated as required across the continuum of care.

Responsibilities

• Providescomprehensivecare coordination to an assigned patient caseload

• Works collaboratively with patients family caregivers healthcare providers and external partners to meet complex medical patient needs

• As part of a multidisciplinary team develops and carries out a treatment planby the use ofa clinical social work diagnosisassessmentand treatment interventions

• Intervenes with patients and familiesregardingemotional social and financial consequences of illness and/or disability

• Assessesmobilizesand provides follow up on family/community resources to meet social care needs

• Provides intervention in cases involving elder abuse/neglect domestic violence guardianship (temporary/permanent) mental health placement and sexual assault

• Initiates andassistspatients with advance directives

• Collaborates with patients/caregivers to include supportive care end-of-life decisions community resources/programs goal setting and long-term planning needs

• Formulates care plan of intervention acceptable to the patient family and health care team

• Receives referrals for complex patient problem resolution from case managers or clinical care team members

• Works in collaboration with the clinical and case management team on transitions of care planning and referrals topost acuteproviders

• Promotes a collaborative process and communication between all health care team members internal multidisciplinary teams inclusive patients/clients families and significant others to ensure the process of integrated care services are targetedappropriate and beneficial

• Advocatesutilizingknowledge of applicable laws regulations government and insurance benefits as well as practice guidelines and standards of practice

• Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system

• Providesfollow upandassistanceto patients in a variety of settings: in-home in-clinic and in the ancillary setting- hospitals group homes skilled nursing facilities etc.

• Documents all interventions in the patient medical record bothtimelyand accurately including all elements of clinic visits in home telephonic engagement or texting

• Maintains knowledge of Medicare Medicaid and other program benefits toassistpatients with resource allocation and choices

• Has freedom todeterminehow to bestaccomplishfunctions within established procedures

• Provides consultation tolow riskguiason patients with significant or intensive community resources needs

• Participates in the development and maintenance of case management metrics

• Provides professional education to staff and community

• FacilitatesSuvidasponsored support groups

• Other duties as assigned by Guia Manager

What Youll Bring

Knowledge Skills and Abilities

• Acute inpatient hospital social work experience preferred

• Experience managing the needs of Senior/Geriatric populations

• Experience assessing and addressing the social determinant of health

• Working knowledge of ICD-10 and Z codes

• Proficiencywith EMRs computers mobile devices medical devices and Microsoft Office Suite

• Excellent therapeutic communication and negotiation skills in interactions with patients families physicians and health care team colleagues

• Exposure and/or experience in pre-acute and post-acute care

• Expertiseconnecting patients and ensuring closed loop referral with community resources and governmental agencies that address complex social needs

• Ability to work independently as well as to develop collaborative relations with physicians families patients interdisciplinary team members and community agencies

Education Experience Licensure or Certification Requirements

• Graduate of an accredited Master of Social Work program (MSW)preferred

• Requires a Licensed Master Social Worker (LMSW)or equivalent3-5 years of experienceANDCHW certification plus 6- 8yearssocial workexperience.

• Must have knowledge of government/community resources as well as Medicare Medicaid long-term care or any other applicable resources/services

• Must have knowledge for transacting LIS PAP and SNAP applications and other foundation applications

• Mustdemonstratecritical thinking skills problem-solving abilities effective communication skills relationship building skills and time management skill

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any typewithregard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.

This policy applies to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absence compensation and training.

Required Experience:

IC