Medical Social Worker-Hospice-GIP
- Roanoke, VA
- Permanent
- Full-time
- Provide psychosocial assessments of patients and families to identify emotional, social and environmental strengths and problems related to their preventative health management, diagnosis, illness, treatment, and/or life situation. Utilize assessment and social work experience to plan and coordinate patient care.
- Formulate, develop, and implement a comprehensive treatment plan utilizing appropriate social work interventions. Coordinate the plan with the care team and make recommendations for further treatment for the patient to achieve his/her optimal level of healthy lifestyle, behaviors and functioning. Evaluate the process at appropriate intervals and modify or change the plan as necessary. Monitors utilization of healthcare resources such as ED, urgent care, admissions or frequent office visits. Collaborates with team to address unnecessary utilization and plan for appropriate support to modify process behaviors. Monitor, evaluate, and record client progress according to measurable goals described in treatment and care plan.
- Arranges, secures, and coordinates assistance with unmet patient/family needs, to include social service, financial, and insurance applications and follow up, medications, DME, and transportation to/from clinic appointments. Plan of care promotes compliance as well as considers appropriate utilization of resources. Advocates on behalf of the patient. Advocates for patients to assist in crises situations.
- Participates in care transitions post hospital and/or ED discharge follow up to assess psychosocial and support needs and reinforces patient self-management expectations and goals.
- Collaborates with other professionals to evaluate patients' medical or physical condition and to assess patient needs.
- Collaborates with community agencies and resources to develop comprehensive knowledge base of available resources for patients and families.
- Refer patient or family to community resources to provide access to services such as financial assistance, legal aid, or housing.
- Participates in care team pre- and post visit case reviews and related meetings. Collaborates with the health care team and/or care coordinator verbally or via chart entries related to the patient's progress toward reaching expected outcomes or about barriers to the plan.
- Meets documentation standards for quality, timeliness and confidentiality of medical records in accordance with organizational and departmental defined policies and procedures.
For employees working in Home Health or Hospice, 2 years of social work experience in case work or counseling in a health care or social services delivery system required. Experience working with end of life patients or home health is preferred. Should possess training and experience in assessing and meeting the emotional and psychological needs at end of life.Other: For employees working in Home Health or Hospice, valid Driver's license, automobile insurance, and personal vehicle for making home visits are required.Must have a clear criminal records check as approved through the Virginia State Police criminal record exchange and found to be clear from barrier crimes. Effective interpersonal, communication, and team working skills required. Must successfully complete orientation and competency validation for position. Demonstrates advanced knowledge of social work theory and practice: proven expertise as a clinical social worker; crisis intervention skills; critical thinking and creative problem solving. Satisfactory completion of orientation; positive interpersonal skills; oral and written communication skills; analytical skills; cultural competence; integrity; team player; courteous; ability/willingness to work as an integral member of a multi skilled team.About CarilionThis is Carilion Clinic ...An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.Requisition Number: 153928
Employment Status: Full time
Location: Carilion Clinic Hospice
Shift: Day
Shift Details: M-F 8-4:30
Recruiter: CHRISTOPHER D FITZGERALD
Recruiter Email: cdfitzgerald@carilionclinic.org
For more information, contact the HR Service Center at 1-800-599-2537.Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status.
Carilion Clinic is a drug-free workplace.Carilion Total RewardsWhat matters to you is important to us—like benefits, rewards, and resources to improve your life. Carilion understands the importance of prioritizing your well-being to help you develop and thrive. When you make your tomorrow with us, we’ll enhance your potential to realize the best in yourself. Below are benefits available to you when you join Carilion:
- Employer Funded Pension Plan, vested after five years (Voluntary 403B)
- Comprehensive Medical, Dental, & Vision Benefits
- Flexible Work Arrangements/Schedules
- Remote Work Options
- Paid Time Off (accrued from day one)
- Onsite fitness studios and discounts to our Carilion Wellness centers
- Access to our health and wellness app, Virgin Pulse
- Discounts on childcare
- Continued education and training