Social Worker MSW

5 days ago

Falmouth, Maine, United States Cape Cod Healthcare Full time
Job Summary

We are seeking a highly skilled and compassionate Social Worker MSW to join our team at Cape Cod Healthcare. As a Social Worker, you will play a vital role in providing discharge planning and counseling services to our patients and their families, recognizing age-specific differences in assessing their needs.

Key Responsibilities
  • Provides discharge planning and counseling services to patients and their families, recognizing age-specific differences in assessing their needs.
  • Screens all admissions to the hospital to determine whether discharge planning services may be needed.
  • Assesses and refers outpatients when required.
  • Provides therapeutic short-term counseling to patients and families.
  • Coordinates discharge planning with patients, families, physicians, staff, and community agencies and facilities, recognizing each patient's requirements relative to their age-specific needs.
  • Determines the type and amount of home care services required by patients and arranges for their care.
  • Determines level of care for patients who need nursing home care.
  • Communicates diagnoses and activities of daily living status to nursing home staff.
  • Coordinates and documents weekly multi-disciplinary rounds to assure that patients in-hospital continuing care needs are met.
  • Provides mental health and substance abuse assessments of hospital patients, recognizing each patient's requirements relative to their age-specific needs.
  • Works with psychiatrists in assessing and treating psychiatric patients. Makes referrals for inpatient psychiatric care and/or outpatient mental health treatment.
  • Assists in the coordination of child abuse and elder abuse procedures.
  • Assists physicians and hospital staff with their mandated reporting obligations.
  • Arranges foster care or adoptions for newborns of maternity patients who choose this option.
  • Coordinates and leads patient-focused conferences with physicians, nurses, and other staff when the need arises.
  • Provides social work support and education for patients and families through special projects such as Cardiac Rehab or cardio-pulmonary rehab.
  • Provides crisis intervention during covered hours.
  • Assists patients and families in filing Medicaid applications with the Department of Public Welfare. Informs patients of Medicaid eligibility regulations.
  • Delivers and explains to patients and families the Medicare termination of eligibility letter.
  • Coordinates the flow of information, including the preparation of the Patient Care Referral Form, between the hospital and other facilities and agencies. Utilizes discretion regarding the appropriate protection and/or use of confidential information.
  • Prepares and obtains patient or family signature on the written discharge plan provided to all who receive aftercare services as required by the DPH.
  • Telephone follow-up of selected discharge patients, as required by the DPH.
  • Maintains social history and current progress notes in patient medical records. Completes correspondence as necessary to expedite appropriate service and referral.
  • Functions as liaison and maintains strong working relationships with community agencies, including extended care facilities, mental health, and home care agencies.
  • Serves on the Psychiatric Patient Care Committee and attends other hospital and community meetings.
  • Provides training and supervision, as appropriate, for social work students as part of their field instruction.
  • Participates in the development of in-service programs for hospital personnel addressing the psychosocial needs of patients and families.
  • Prepares and submits monthly statistical and quality assurance reports.
  • Assists in fulfilling audits and other federal, state, and JCAHO requirements.
  • Assists in assuring the utilization of acute hospital beds.
  • Participates in appropriate conferences, workshops, and courses to enhance and stimulate the professional awareness of innovative medical social work programs and services.

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