Medical Social Worker Per Visit Nantucket, VNA of Cape Cod

2 months ago


Plymouth, United States Cape Cod Healthcare Inc. Full time

1. Acquires all pertinent information relating to the patient and the issues requiring social work intervention when appropriately requested by the MD's, patient, significant other, or through an intra-agency referral.

2. Develops a plan of care based on evaluation and established goals, in collaboration with the patient's physician, and based on the patient/family ability and/or wish to participate.

3. Assess the strength of patient and/or family, what social and internal stresses they face, what their coping capabilities are and what goals they seek.

4. Arrives at a psycho-social diagnosis and a realistic goal that patient and/or family can achieve.

5. Counsel's patient and/or family as needed to help them cope with or resolve those conditions that inhibit their functioning.

6. Participates in inter-disciplinary patient case conferences; evaluates effectiveness of established plan of care.

7. Refers to other disciplines as indicated by patient's medical status, functional status, communication needs.

8. Communicates clinical findings, treatment plan, goals, frequency/duration, and referrals to MD and other involved care providers.

9. Re-evaluates patient status and effectiveness of the plan of care on an on-going basis.

10. Notifies MD/other involved care providers of significant changes in the patient's condition.

11. Records narrative documentation to reflect skilled care. Documentation is clear, concise and addresses specifics of teaching, direct care and response of patient / caregiver.

12. All other duties as assigned.

Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects VNA's commitment to CARES: compassion, accountability, respect, excellence and service.

* Bachelor of Science Degree or Master's Degree in Occupational Therapy from an institution accredited jointly by the American Occupational Therapy Association and the committee on Allied Health Education and Accreditation of the American Medical Association.
* Current OT license in Mass.
* Minimum one (1) year clinical experience and CPR certification required.
* Computer skills preferred.



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