Location: Identified Agrace new market areas

Full Time .8 FTE (32 hours/week) | Day Shift | Monday-Friday | 8am-5pm

Includes shared on call responsibilities

Includes 20% travel premium and paid travel expenses

Make a lasting impact with Agrace

Join Agrace, a nationally recognized nonprofit leader in hospice and palliative care. If you are a skilled Social Worker who values meaningful, patient-centered care, this is your opportunity to make a difference!

How You’ll Make a Difference (Essential Functions)

Travel Resource SW is responsible for patient and family satisfaction through the provision of direct social work services by conducting assessments, providing interventions, creating and updating the plan of care, communicating, and documenting. The Travel Resource SW is fulfilling temporary social work assignments throughout new hospice markets, as well as within currently established homecare teams when a need arises (vacancies, FMLA, high census). The Travel Resource SW provides patient and family centered care consistent with Agrace philosophy, goals, standards, regulations and policies.

Key Responsibilities

• Provide customer service to patients and families and assist with enrollment

  • Travel within the Agrace geographic service area to meet with patients and families.

  • Lead conversations with patients and families to convert appropriate referrals to admissions.

  • Answer questions about Agrace values, services, benefits and philosophies.

  • Overcome objections to enrolling in hospice or palliative care and create a sense of urgency with each referral.

  • Obtain informed consent for hospice services and complete Electronic Health Records (EHR) documentation. Complete insurance paperwork, DME orders, pharmacy service enrollment, etc.

  • Provide required documentation and referral process information to healthcare facility partners, Health Information Management (HIM) Department and homecare team or inpatient unit.

  • Provide essential healthcare coverage and financial information to the Finance Department.

  • Collaborate with discharge planners and hospital staff to ensure ease of transition from hospital.

  • Assist with incoming referrals to Agrace services

  • Facilitate follow-up and flow of information and legal documentation to admissions team and partners to support enrollment with Agrace.

  • Schedule Agrace enrollments and consults.

  • Provide scheduled and unscheduled informational visits and tours to potential patients and families.

  • Collaborate with other members of the Admissions team and other teams to ensure smooth transition from referral to admission and thereafter.

  • Assist in training and providing shadow opportunities for internal and external partners when assigned

• Initial and Ongoing Patient/Family Assessments

  • Assess patient and family psychosocial, spiritual, grief and educational needs as part of the initial and comprehensive as per the patient’s individualized Plan of Care (POC).

  • Advocate for patient/family goals.

  • Coordinate transition planning in collaboration with the patient/family, homecare, and Interdisciplinary Team (IDT).

  • Anticipate and respond to patient/family psychosocial, spiritual, resource, or grief needs. Round on patients.

• Care Planning and Coordination

  • Collaborate with IDT and patient/family to formulate, implement, and revise individualized Plan of Care

  • (POC) in the electronic health record (EHR). The POC includes goals, interventions, education, discharge

  • plan, etc.

  • Read, understand, and follow POC. Document education, interventions, and outcomes in EHR.

  • Intervene, document, and report significant changes in condition or unusual incidents to appropriate IDT member such as client abuse/neglect, suicidal intent, harmful coping mechanisms or violence, etc.

  • Facilitate communication among patients, families, and Agrace staff.

• Education, Intervention, and Resources

  • Provide individual patient/family education and support regarding behaviors, emotions, and psychosocial adjustment to terminal illness, dying, and bereavement. Evaluate the effectiveness of education and adjust to meet needs.

  • Provide appropriate education and interventions for patient/family based on clinical assessment and patient/family goals. Evaluate the effectiveness of interventions and adjust to meet needs.

  • Develop and maintain knowledge of community, legal, Agrace, and hospice specific resources. Refer patients/families to resources. Act as patient/family advocate to obtain resources.

  • Assist with Power of Attorney for Health Care (POAHC), Financial Power of Attorney, Living Will, and Guardianship including assistance with POAHC capability and competency assessment.

  • Primary Preceptor for new market assignments

• Miscellaneous

  • Participate in meetings to plan and evaluate patient/family services.

  • Participate in SW on-call rotation.

  • Participate in education and outreach.

  • Participate and complete volunteer competency visits annually.

  • Participate in death visits, including assistance with post-mortem cares using safe body mechanics.

  • Precept new staff and students.

  • MSW may audit or oversee the work of BSW

You Bring (Qualifications)

• Bachelor’s in Social Work (BSW), required; Master’s in Social Work (MSW), preferred.

• Current, unrestricted Social Work License in state of employment

• One-year paid medical social work experience required

• Valid driver’s license, auto insurance, and access to a reliable vehicle

• Must be at least 18 years of age

• Fulfill travel assignments as identified or based upon commitment/contract

• Travel experience preferred

• Ability to maintain professional boundaries with patients, families and co-workers

• Ability to create and follow plans of care, and patient, family, and clinical staff directions

• Intermediate Microsoft Office skills

• Intermediate electronic health records skills; Epic preferred

• Ability to maintain confidentiality about patients, families, caregivers, staff, donors, and organizational intellectual property

• Ability to use proper body mechanics, safe patient handling, and standard precautions

Benefits

• Competitive pay with mileage reimbursement
• Health, dental, and vision insurance for employees who are hired for 28+ hours per week (.7 FTE +)
• Retirement plans with employer matching
• Generous Paid Time Off (PTO) and holiday paid time off
• Comprehensive onboarding, mentorship, and career development

About Agrace

For more than 45 years, Agrace has been an innovator and leader in both caring for patients and their families, and in educating others about death, dying and grief. We are the largest hospice provider in Wisconsin. Well known for end-of-life care, Agrace also serves people across southern Wisconsin who are aging, seriously ill or grieving.

At Agrace we are strengthened by the unique experiences, cultures and traditions of our staff, patients and clients.

Together, we pursue a vision in which every Agrace staff member is treated fairly, and every patient and client experiences the respectful, individualized care they need and deserve.

We foster a culture of belonging that celebrates people’s uniqueness and leads to meaningful, empathetic connections.

Agrace HospiceCare is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.