Clinical Care Social Worker

United Hospital Center; Bridgeport (WV); On-site; USD 50,000 - 60,000; Full time

Job summary

United Hospital Center in Bridgeport, WV, seeks a social worker to coordinate care for WVU Medicine patients across the continuum. You will perform psychosocial assessments, crisis intervention, discharge planning, and referrals to post-acute services, collaborating with a multidisciplinary care team to support complex cases.

Requirements include a Master’s degree in Social Work and state licensure. You will manage transition/discharge plans, connect patients with community resources, and

Qualifications

• Masters degree in Social Work.
• Current social worker licensure as required by the state where work is being performed.
• WV: LGSW, LCSW, or LICSW through WV Board of Social Work; MD: LMSW or LCSW-C through MD Board of Social Work.
• Licensed social workers must meet state-specific licensure requirements.

Responsibilities

• Manages all aspects of transition/discharge planning for assigned patients.
• Collaborates with the multidisciplinary team to facilitate transition/discharge for designated caseload.
• Monitors patient progress and ensures plans of care are patient-focused, high quality, cost-effective.
• Maintains knowledge of federal, state, and local assistance programs and community resources.
• Provides education to staff, physicians, patients and families to ensure effective transition planning.
• Meets with patient/family to assess needs and develop individualized transition/discharge plans.
• Provides social work assessment/interventions for complex crises (mental health, substance abuse, etc.).
• Facilitates referrals to post-acute services (Homecare, DME, Hospice, SNF, etc.).
• Documents interactions and progress per regulatory policies.

Skills

Interpersonal communication

Negotiation skills

Diversity & inclusion

Education

MSW degree

State licensure

Job description

Welcome! We’re excited you’re considering an opportunity with us! Below, you’ll find other important information about this position.

This position comprehensively plans for the coordination of care for the WVU Medicine patient population across the continuum. Performs psychosocial assessments, crisis intervention, resource management, discharge planning, care facilitation, and referrals to alternate levels of care. Works collaboratively with the multidisciplinary care team to facilitate achievement of desired treatment outcomes. The position intervenes with patients who have complex psychosocial needs, require assistance with eligibility determination for social programs and funding sources, and qualify for community assistance from a variety of special funds and agencies. In addition, may offer crisis intervention to patients and families with psychosocial needs and collaborates with the patient care team in the development of a transition/discharge plan of care for all patients.

Minimum Qualifications

Education, Certification, and/or Licensure

• Masters degree in Social Work
• Current social worker licensure as required by the state where work is being performed.

WV: Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW) or Licensed Independent Social Worker (LICSW) through the West Virginia Board of Social Work

MD: Licensed Masters Social Worker (LMSW) or Licensed Certified Social Worker – Clinical (LCSW-C) through the Maryland Board of Social Work

Experience

Preferred Qualifications

• One to three years of experience preferred

Core Duties and Responsibilities

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner using escalation processes as needed when barriers encountered.
• Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload
• Monitors the patient’s progress; intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective
• Maintains extensive knowledge of federal, state, and local assistance programs and community resources that affect patient needs.
• Demonstrate appropriate professional practice, maintaining respect for confidentiality and freedom of choice as outlined by the Code of Ethics by the National Association of Social Workers as well as the State Board of Social Workers.
• Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team
• Provides social work assessment and interventions for complex crisis including but not limited to mental health, substance abuse, adjustment to health status and grief/loss situations.
• Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning
• Initiates and facilitates referrals to post-acute services- including but not limited to- Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities
• Communicates all necessary information regarding transition/discharge plan to the multidisciplinary team, patient and family. Assists other team members to understand and appreciate a patient and/or family’s reaction to a serious illness and/or chronic illness/disease as well as to understand other environmental factors affecting care, treatment and compliance.
• Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to regulatory policies and procedures.
• Working knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc.
• Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives
• Utilizes clinical skill and expertise to provide assessment, intervention, and where appropriate, reporting for complex abuse, neglect, Foster Care, adoption, Mental health placement, homelessness, domestic violence, and sexual assault situations.
• Collaborate for appropriate resource and financial management which may include but is not limited to-financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination
• Communicates with the Care Management Resource Center and/or third party payors to facilitate covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis with clinical staff (Ie: peer to Peer) and follows up to resolve problems with payors as needed
• May require occasional coverage to outpatient services including but not limited to LVAD assessment/services, Transplant psychosocial assessments and services and for coordination of discharge services with the outpatient organ transplant/LVAD clinic staff.
• Uses quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions
• Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials
• Fosters the integration of staff and/or students into the healthcare team
• Exhibits professional behavior on a consistent basis
• Required on call and weekend/holiday rotations as needed

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skills And Abilities

• Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues.
• Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change
• Capable of independent judgment and action regarding psychosocial needs of patients.

Additional Job Description

Monday - Thursday Four-10 hour shifts - Emergency Room SHIFT: 9:00 AM - 7:30 PM

Scheduled Weekly Hours

40

Shift

United States of America (Exempt)

Company

UHC United Hospital Center

Cost Center

405 UHC Quality Management

Address

327 Medical Park Drive

Bridgeport

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.