Medical Social Worker

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Job Summary:

Key Position Details:

Will have a weekend rotation included in work schedule agreement.

Job Description:

• Delivers professional and thorough social work services, including psychosocial assessment and intervention planning.
  • Identifies patients who require social work assessment and intervention through high risk screening, interdisciplinary team meetings and individual referrals.
  • Conducts assessments that address bio-psycho-social issues for age, population and health specific needs which results in individualized plans of care.
  • Provides support and counseling to patients and families.
  • Provides information and assistance for identified financial or social needs.
• Coordinates complex transition plans with patients, families, health care team and community providers.
  • Utilizes the electronic medical record to monitor, document and communicate patient progress toward goals and progression of the social work plan.
  • Collaborates and communicates with interdisciplinary team anticipating needs to move the plan of care forward.
  • Provides support and information to patient and families regarding transition plan.
  • Maintains knowledge of government and private payer networks and services to assure appropriate transitions.
  • Collaborates with community and health care resources based on need to coordinate care for the patient.
• Advocates for patients and families by supporting patient rights and accessing protective services.
  • Demonstrates awareness of patient rights and ethical decision making; provides advocacy to support patient and family.
  • Assures appropriate reporting of vulnerability or suspected abuse as mandated by law.
• May participate in care system process that prevent readmissions.
  • Plans and participates in transition conferences with patients and families.
  • Utilizes tools and technology to identify and intervene with patients who are at risk for readmission.
  • Ensures that a complete clinical handoff occurs for at risk patient, which may include referrals.
• May collaborate with the health care team to promote appropriate length of stay.
  • Utilizes tools and technology to support appropriate length of stay management.
  • Facilitates timely referrals and transfers of information.
• Other duties as assigned.

• Bachelor's degree in Social Work required or
• Master's degree in Social Work preferred
• WI licensure degree requirements will be accepted in accordance with MN Board of social work requirements for licensure by endorsement
• 0 to 2 years of experience in a acute care setting preferred
• 2 to 5 years social work experience preferred
• Licensed Social Worker - MN Board of Social Work required or
• Licensed Social Worker - WI Dept of Safety & Professional Services required
• Valid Driver's License required upon hire - MN and WI residents must obtain a valid driver's license in their state of residence within 60 days of employment for positions in Hospice and Home Health
• Care Management Certification for positions in Care Management within 2 years of hire required. Any current employee will need to complete certifications requirements by 12-31-2024 or at the earliest date when certification work experience requirements have been met.