Patient Care Coordinator

6 days ago

Fond du Lac, Wisconsin, United States Generations Hospice Full time
About the Role

We are seeking a compassionate and skilled Hospice Social Worker to join our team at Generations Hospice. As a key member of our interdisciplinary team, you will play a vital role in providing medical social work services and coordinating care to ensure our patients and their families have an optimal experience.

Responsibilities
  • Assess the psychosocial status of patients and families/caregivers related to the patient's terminal illness and environment, and communicate findings to the registered nurse and other members of the interdisciplinary group.
  • Provide social evaluations, including family dynamics, caregiver abilities, communication patterns, high-risks for suicide, neglect or abuse, and plan intervention based on evaluation findings.
  • Counsel patient and family/caregivers as needed in relationship to stress, and other identified coping difficulties.
  • Provide crisis intervention when necessary.
  • Assess for, and educate interdisciplinary group, on any special needs related to the culture of the patient and family, including communication, role of family, space, and any special traditions or taboos.
  • Maintain clinical records on all patients referred to social work.
  • Educate patients and families on, and assist in, preparation of advanced directives.
  • Provide information and referral services for organization patients and families/caregivers regarding practical and environmental needs.
  • Provide information to patients and families/caregivers and community agencies.
  • Serve as liaison between patients and families/caregivers and community agencies.
  • Maintain collaborative relationships with organization personnel to support patient care.
  • Maintain and develop contracts with public and private agencies as resources for patient and personnel.
  • Participate in the development of the individualized plan of care, involving the patient and family, and attend regularly scheduled interdisciplinary group meetings, assisting the team in recognizing the effects of the psychosocial stresses on the symptoms of the terminal illness.
  • Assist physician and other team members in understanding significant social and emotional factors related to health problems and death/dying issues.
  • Actively participate in quality assessment performance improvement teams and activities.
  • Assist family and patient in planning for funeral arrangements, financial, legal, and health care decision responsibilities.
Requirements
  • A graduate of a master's program in social work (MSW) accredited by the Council on Social Work Education.
  • OR A graduate of a bachelor's program in social work accredited by the Council on Social Work Education. Meets personnel qualifications stated in § b)(3).
  • Minimum of one (1) years' experience in health care, hospice experience preferred.
  • Understands hospice philosophy, and issues of death/dying.
  • Experience in a hospice care preferred.
  • Demonstrates good verbal and written communication, and organization skills.
  • Current licensure according to Medicare guidelines to practice in state of operation.
  • Must be a licensed driver with an automobile that is insured in accordance with state or organization requirements and is in good working order.

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