Geriatric Social Worker — Care Coordination & Discharge

Pioneer Health Care Management Inc; Sterling Heights (MI); On-site; USD 42,000 - 64,000; Full time

Job summary

Pioneer Health Care Management Inc. seeks a Social Worker - Lakeside in Sterling Heights, MI to identify residents' social, emotional and psychological needs and develop care plans.

You will educate families about post-acute options, coordinate with the interdisciplinary team, and document assessments and care conferences in the EMR.

This full-time role requires a Bachelor’s in social work or related field and at least one year of supervised health-care social work experience.

Qualifications

• Bachelor's degree in social work or related field.
• 1 year of supervised social work experience in a health care setting.

Responsibilities

• Complete and document Social Work and Psychosocial assessments for all residents within 3 days of admission or readmission.
• Ensure 3877/78 forms are completed and accurate, upon admission and annually.
• Schedule and document 72-hour Resident Care Conference for admissions and readmissions, and notify the IDT by email with date, time, resident and attendance.
• Complete MDS sections and the appropriate CAAs.
• Complete, review and update Care Plans including Psychosocial, Discharge Planning, Behavioral, Cognitive loss, mood, vision, hearing; ensure diagnoses and medications are captured.
• Monitor the behavior log book and follow up on new or changed behaviors.
• Coordinate care with the psych provider including medication management and consents.
• Coordinate all ancillary services (Dental, Ophthalmology, Audiology) with input from DON/Administrator.
• Educate residents and families related to Advanced Directives; complete Advance Directive and Code Status within 48 hours of admission.
• Arranges DME and Home Care at discharge and maintains relationships with community health resources.

Education

Bachelor's degree in social work or related human services field

Job description

Pioneer Health Care Management Inc. seeks a Social Worker - Lakeside in Sterling Heights, MI to identify residents' social, emotional and psychological needs and develop care plans.

You will educate families about post-acute options, coordinate with the interdisciplinary team, and document assessments and care conferences in the EMR.

This full-time role requires a Bachelor’s in social work or related field and at least one year of supervised health-care social work experience.