MUST HAVE: MDS, Care plan and discharge experience

ONLY with NURSING HOME EXPERIENCE !

Job Description:

Bi-lingual Russian and/ or Spanish preferred

• Will assist department in providing education, in-service, orientation and training to social work students, interns or volunteers.
• Responsible for completion of timely assessments and documentation in resident medical records including MDS assessments, admission notes, psychosocial assessments, quarterly and annual assessments, SS progress notes, comprehensive care plan, peer abuse assessments, etc.
• Will manage assigned caseload. This includes the completion of assessments, attending scheduled meetings, follow up with residents and families, etc.
• Will facilitate timely room and unit changes by providing advance notification to residents and designated representatives, preparing residents for anticipated changes, and ensuring prompt communication with members of the interdisciplinary team.
• Will attend all mandatory in-service education programs and other educational programs in an effort to keep current on nursing home regulations and programming.
• Will participate in interdisciplinary committees and program development as assigned.
• Will assist residents and families in meeting concrete/personal needs i.e. clothing/shoes, burial plans, etc.
• Will assist residents and families in addressing concerns with members of the interdisciplinary team by facilitating effective communication, submission of grievance forms, and follow up on grievances as assigned by the Director to ensure timely investigation and resolution with residents and families.
• Will follow up with new admissions and families to help facilitate their adjustment to placement.
• Will participate in environmental rounds in an effort to identify and address safety issues and communicate with appropriate disciplines identified.
• Will communicate with members of the interdisciplinary team to ensure that resident psychosocial needs are effectively met. Will make referrals to mental health providers and facilitate psychiatric hospitalizations as appropriate.
• Will educate residents and families about advance directives and health care decision- making. Will make referral to facility Ethics Committee as appropriate.
• Will identify residents who may benefit from palliative and hospice care services and make referrals as appropriate.
• Will coordinate team discharge planning efforts for individual residents, make referrals to community service providers, housing, alternate SNFs/adult homes/ assisted living programs, etc. in an effort to provide safe and appropriate discharges. Will follow up with resident and/or designated representative post discharge.
• Will address all incidents of alleged abuse, neglect or mistreatment, resident to resident altercations and roommate conflict in a timely manner to prevent further incidents. Will follow facility policy and procedure relating to abuse prevention.
• Will provide counseling to residents as needed for issues relating to adjustment, non-compliance, smoking safety, roommate conflict, safety, loss and bereavement, etc.
• Other duties as assigned by the Director of Social Services/designee.

We are EOE

IND2

Job Type: Full-time

Pay: $55,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person