About Job
- Psychosocial Assessment: Conducting assessments to understand patients' emotional, social, and psychological needs, as well as any barriers to treatment.
- Patient Education and Counseling: Providing patients and their families with information about CKD, treatment options, and lifestyle changes, as well as offering emotional support.
- Coordination of Care: Helping patients navigate the healthcare system by coordinating services such as transportation, financial assistance, and access to insurance benefits.
- Crisis Intervention: Assisting patients in managing crises, such as emotional distress or challenges in adhering to treatment.
- Advocacy and Resource Referral: Ensuring patients receive the necessary resources, like support groups, mental health services, and other community programs.
- Long-Term Adjustment Support: Helping patients cope with the lifestyle adjustments that come with chronic kidney disease and dialysis treatment
- Conducts an initial psychosocial assessment on patients new to ESRD, treatment modality or the facility within two weeks of admission for preliminary evaluation and annually thereafter.
- Provides support, information, and assistance in treatment planning.
- Analyzes and provides information and facilitates referrals to community, private, state and federal agencies based on psychosocial need (e.g. financial programs, medication assistance programs, Vocational rehabilitation programs, transpiration resources, mental health and chemical dependency resources and home health/homemaking agencies).
- Provides crisis intervention expertise as necessary.
- Develops treatment and psychosocial goals for initial short term and long-term care plans.
- Acts as an advocate on behalf of the patient and family.
- Counsels net patients and families on pre-dialysis education, including treatment modalities, and Advance Directives.
- Notifies multi-disciplinary team of any patient psychosocial issues affecting treatment and compliance.
- Facilitates and/or refer patients and families to support/educations groups, whenever possible.
- Analyzes and provides information and facilitate referrals to community, private, state and federal agencies based on psychosocial need (e.g. financial programs, medication assistance programs, transportation, vocational rehabilitation programs, and mental health and chemical dependency resources).
- Provides assistance to patient and family in adjusting to dialysis and an altered life-style, and provide resource information.
- Provides information to the Clinical Coordinator/ Facility Administrator and Administrative Assistant related to patient travel arrangements.
- Assists regarding health insurance:
- Assists patients with financial concerns in obtaining assistance through National Kidney Foundation, American Kidney Fund, state renal programs, Veterans Administration, etc.
- Supports patient questions regarding Medicare and Medicaid, coordinate assistance entitlements and all appropriate documents.
- Assists staff provides staff education for potential behavioral problems; assists with difficult and challenging patients, devising action place to include setting limits, developing contracts and other practices deemed necessary; acts of mediator of conflicts if necessary.
- Maintains confidentiality of patent, staff, and company information.
- Coordinates and participates in patient/family care conferences with multidisciplinary team, participates in monthly CQI meetings.
- Provides documentation in the medical record or the initial and on-going psychosocial assessments that will address both problems and strengths of the patients which will guide treatment planning/decisions and delivery of care.
- Other duties as assigned.
- State license in Clinical Social Work
- Master’s Degree in social work (MSW)
- At least two years of experience as a social worker in a health care setting
- Capable of communicating clearly and effectively with all types of physically and mentally disabled patients and their families
Professional Field



Patient Focus
Diagnoses
Avoidant Personality Disorder
Issues
Aging
Medication Management
Stress
Therapeutic Approach
Methodologies
ECT
Pharmacotherapy
Modalities
Families
Practice Specifics
Populations
Victims of Crime/Abuse (VOC/VOA)
Aviation/Transportation
Racial Justice Allied
Settings
In-patient Non-Psychiatric
In-patient Psychiatric
Residential Treatment Facilities (RTC)
Schools
Substance Abuse Treatment Facilities
Home Health/In-home
Military
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