Medical Social Worker

Heywood Hospital • Gardner, MA • 4h ago

GARDNER Medical Social Worker Social Services, 40-Hours, Days, Monday -
Friday, Every other weekend Essential Functions Care Transitions &
Coordination: Reports directly to the Manager of Care Transitions and
Indirectly reports to Unit Manager and Practice Leader. Keeps department
leaders abreast of any issues, trends identified and/or needs weekly
and/or more frequently if needed. Demonstrates professionalism and
teamwork. Works collaboratively with unit team and responds timely,
efficiently and respectfully. Covers for co-workers during planned and
un-planned absences and as requested by leadership. Provides service to
community at large through the provision of service to Walk-In and
telephone inquires as assigned by leader and/or designee as needed.
Conducts comprehensive psychosocial assessments for patients and
families. Identifies social, emotional, financial, and environmental
barriers to care. Assesses mental health concerns, coping ability and
support systems. Completes the Assessment fully, clearly, concisely, and
within 24-48 working hours of being assigned the case. Completes
documentation using the documentation standards noted by department
policies and procedures, as well as, state and federal regulations.
Completes clear and concise documentation noting patient and family
participation, multidisciplinary involvement, and other planning
information as required by the department, as well as, state and federal
regulation agencies. Discharge Planning: Communication: builds rapport
and responds to needs of physician, healthcare team members, 3rd party
payers, referral sources and vendors to enhance internal and external
customer service satisfaction. Conducts High Risk Screening on all
patients on assigned units for potential needs as per policy. Completes
HRSN Screen within 24 working hours of case assignment. Effectively
supports the discharge planning process by ensuring services and
placements are appropriate within the continuum of care. Completes
required documentation accurately and in a timely manner, maintaining
compliance with regulatory standards. Demonstrates strong performance in
educating patients on their rights, consistently providing accurate,
timely, and comprehensive information. Ensures patients understand
applicable processes and resources, supporting informed decision-making
and maintaining compliance with regulatory and organizational standards.
Provides short-term counseling to patients and families coping with
illness, trauma, grief or adjustment challenges. Supports patients
dealing with chronic illness, terminal diagnoses or major life changes.
Effectively provides patients and families with clear, relevant
education regarding the care plan, tailored to individual needs.
Collaborates closely with the multidisciplinary team to ensure
coordinated, patient-centered care and support continuity across
settings. Responds to psychosocial crises, including: Domestic violence,
abuse or neglect concerns, suicidal ideation and family conflict.
Advocates for patients\' rights, dignity and access to appropriate care.
Addresses barriers related to social determinants of health. Conducts
post discharge follow up on High Risk patients in an attempt to reduce
re-hospitalization. Job Requirements Minimum Education Associates Degree
required, Bachelor\'s Degree preferred in SW or related field Minimum
Work Experience Minimum one to three years experience in a hospital
setting, Skilled Nursing Facility, or community social/health agency.
Minimum Licenses and Certifications MA State licensure required LCSW,
LSW, or LSWA.

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