DESCRIPTION. – Participates in a systematic process of collecting in-depth information about the member’s situation and functioning. This process is to identify individual needs, educational and cultural background, physical or social determinants in order to develop a comprehensive plan of care that will address those needs utilizing required assessment tools. – Collaborates with the Primary Care Physician/Specialist to ensure the plan of care promotes patient self-management. – Performs careful ongoing evaluation and follow-up of the member’s situation in order to monitor and intervene as ne... view job details
Under the direction of the Sr. Director of Clinical Services, the Medical Social Worker understands the processes needed to ensure patient specific continuity of care during the transition to alternate levels of care. This individual is knowledgeable of development needs across all age groups including the elderly. A. SPECIFICS. · Partners with the Discharge Planner/Care Managers to work with the patient, family, and physician to facilitate a safe and effective care transition plan that meets the needs of each patient. · Using a variety of therapeutic modalities, the MSW assists patients and f... view job details