A Pineywoods Home Health

Lufkin/Angelina County Chamber of Commerce; Lufkin (TX); On-site; USD 52,000 - 78,000; Full time

Job summary

Pineywoods Home Health in Texas is seeking a skilled social worker to provide coordinated home health care across age groups. The role involves psychosocial assessments, case coordination, and referrals to meet patient and family needs while collaborating with physicians and the health-care team.

The ideal candidate demonstrates strong communication skills, adherence to plan of care, and active participation in ongoing professional development and agency training.

Responsibilities

• Performs psychosocial assessments for patients/clients and identifies their psychosocial, financial, environmental, and community resource needs.
• Develops and evaluates the plan of care in partnership with the patient, representative, and caregiver(s).
• Provides counseling and education to patient/client and family as ordered by the physician and Plan of Care.
• Maintains timely and accurate clinical notes and contributes to documentation standards.
• Collaborates with the interdisciplinary team to promote coordination of patient care.
• Participates in the Agency’s QAPI program and in-service trainings.

Job description

Provides coordinated care in the home to patients/clients of all age groups and performs psychosocial assessments, analysis, counseling, and referrals to meet the needs of the patient/client and family. Participates in the coordination of care.

Performsongoingclinicalassessmentofhomehealthpatients/clientstoidentifypsychosocial,financial,environmental, and community resource needs asevidencedby the Plan of Care (POC), documentation, clinical records, case conferences, and community resource referrals.

Developsandevaluatestheplanofcareinpartnershipwiththepatient/client,representative(ifany),andcaregiver(s).

Acceptsclinicalassignmentsthatareconsistentwitheducationandcompetencetomeettheneedsofthepatients/clients.

ProvidesservicesthatareorderedbythephysicianasindicatedinthePlanofCare,includingpatient/client,caregiver, and family counseling, and patient/client and caregiver education.Prepares clinical notes.

Useseffectiveinterpersonalrelationsandcommunicationskills;facilitatestheuseoftheseskillsbyotherteam members to achieve desirable outcomes.

CommunicateswithallphysiciansinvolvedinthePlanofCareandotherhealthcarepractitionersrelatedtothecurrent Plan of Care.

MeetsmandatorycontinuingeducationrequirementsoftheAgencyandlicensingboard.

Demonstratescommitment,professionalgrowth,andcompetencybymaintainingaworkingknowledgeofpublicand private eligibility standards and requirements.

PromotestheAgencyphilosophyandadministrativepoliciestoensurequalityofcare.

Collaborateswiththeinterdisciplinaryteamtopromotecoordinationofpatient/clientcare.

Meets productivity standards as outlined by the agency.

Meets or exceeds agency documentation standardstimelyand efficiently

ParticipatesintheAgency’sQAPIprogram.

ParticipatesintheAgencysponsoredin-servicetrainings.

Providessupervisionofsocialworkassistants,ifapplicable.

Additional Postings available from A Pineywoods Home Health