Social Worker

Social Worker

Requirements

• Bachelor’s degree in Social Work
• Licensed Social Worker – MN Board of Social Work required
• Licensed Social Worker – WI Dept of Safety & Professional Services required (if working in Wisconsin or interacting with Wisconsin patients remotely)
• Valid Driver’s License required upon hire – MN and WI residents must obtain a valid driver’s license in their state of residence within 60 days of employment for positions in for Home Care, Palliative Care Community, Senior Care and System ACT Advanced Care

Responsibilities

• Delivers professional and thorough social work services, including psychosocial assessment and intervention planning.
• Identifies patients who require social work assessment and intervention through high risk screening, interdisciplinary team meetings and individual referrals.
• Conducts assessments that address bio-psycho-social issues for age, population and health specific needs which results in individualized plans of care.
• Provides support and counseling to patients and families.
• Provides information and assistance for identified financial or social needs.
• Coordinates complex transition plans with patients, families, health care team and community providers.
• Utilizes the electronic medical record to monitor, document and communicate patient progress toward goals and progression of the social work plan.
• Collaborates and communicates with interdisciplinary team anticipating needs to move the plan of care forward.
• Provides support and information to patient and families regarding transition plan.
• Maintains knowledge of government and private payer networks and services to assure appropriate transitions.
• Collaborates with community and health care resources based on need to coordinate care for the patient.
• Advocates for patients and families by supporting patient rights and accessing protective services.
• Demonstrates awareness of patient rights and ethical decision making; provides advocacy to support patient and family.
• Assures appropriate reporting of vulnerability or suspected abuse as mandated by law.
• May participate in care system process that prevent readmissions.
• Plans and participates in transition conferences with patients and families.
• Utilizes tools and technology to identify and intervene with patients who are at risk for readmission.
• Ensures that a complete clinical handoff occurs for at risk patient, which may include referrals.
• May collaborate with the health care team to promote appropriate length of stay.
• Utilizes tools and technology to support appropriate length of stay management.
• Facilitates timely referrals and transfers of information.
• Other duties as assigned.

Preferred Qualifications

• Master’s degree in Social Work
• Experience in an acute care setting
• 2+ years social work experience