Social Worker

2 days ago

Minneapolis, Minnesota, United States Allina Health Full time
Job Summary

Allina Health is a not-for-profit health system that prioritizes patient-centered care. As a Social Worker, you will play a vital role in providing exceptional support to patients and families.

Our mission is to deliver whole person care, investing in the well-being of our patients and staff. We are committed to enriching the careers of our team members and fostering a culture of compassion and excellence.

Key Position Details
  • Full-time position (40 hours per week; 1.0 FTE)
  • Days (8 hour shifts)
  • No weekends
  • Benefit eligible
  • This role is part of a multidisciplinary Complex Care Management team
Job Description

As a Social Worker, you will provide patients and families with the psychosocial support needed to cope with chronic, acute, or terminal illnesses. Your services will include advising family caregivers, providing patient education and counseling, and making referrals for other services.

You will also provide care and case management or interventions designed to promote health, prevent disease, and address barriers to access to healthcare.

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

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