Job Details

Description

Job Summary

This is a full-time position. This position is responsible for providing social work services within Transitions Palliative Care (TPC). The responsibilities of the position will include introduction and education around palliative care, knowledge of all Transition LifeCare (TL) service lines and involvement in special programs, conversations related to patient goals and counseling around life-limiting illness management, and resource support for the patient/family. This position may require visits to patients homes/hospitals/and facilities. The schedule for this position is Monday-Friday 8:30-5:00; holiday rotation.

Responsibilities What You Do

• Provide psychosocial assessments of patients and families to identify emotional, social, and environmental strengths and concerns related to their diagnosis, illness, treatment, and life situation.
• Help patients and families to articulate goals of care, utilizing appropriate clinical social work treatments and intervention, while maintaining the dignity of the patient.
• Document assessments, care plans, interactions, and interventions according to regulatory and agency standards.
• Work collaboratively with all palliative care team members, including special programs, in identifying and achieving patient care goals.
• Provide education and counseling to patients and families around issues related to adaptation to the patient's diagnosis, illness, treatment and/or life situation.
• Provide teaching, orientation, and education to families about palliative care (including special programs) and hospice.
• Identify clinical or operational performance improvement opportunities and participate in performance improvement activities.
• Participate in regular supervisory conferences; maintain current knowledge of social work and health care developments related to PC and Hospice
• Maintain working knowledge of and liaison with community agencies and resources; assess and refer patient/family to appropriate resources.
• Responsible for professionally managing time, people and technology.
• Support patient/family’s individual spiritual/cultural beliefs by assessing for cultural issues; developing culturally sensitive care plan and collaborating with interdisciplinary team in provision of culturally sensitive care.
• Provide bereavement outreach for Palliative Care families.
• Performs other duties as assigned by supervisor.
  
  

Expectations how you do it

• TL Core Values are exemplified in all interactions with internal and external customers.
• Adheres to TL policies, procedures and guidelines.
• Adheres to CMS and state guidelines and social work standards of practice.
• Adheres to NHPCO Ethical Practices and the National Association of Social Worker’s Code of Ethics.
  
  

Requirements What You Need

• BSW or MSW from accredited university with a minimum of one year experience in health-related field (experience may include social work internships in a health care related organization).
• Knowledgeable about reimbursement sources, Medicare regulations, licensing laws, and accreditation standards.
• Expert computer skills
• Must have reliable transportation.
• Must be able to travel to, enter and function in homes/hospitals/facilities in the service area to assess and provide care to all patients.
• May be required to lift and/or carry items up to 50 pounds.
• Must have sensory abilities to complete physical assessment, communicate with patient/family care providers and physician and to complete the reporting and follow-up documentation responsibilities of the job.
• Work hours and days including weekend and holiday commitments as outlined in Employee Information Agreement.