Hospice Homecare Social Worker

Agrace; Watertown (WI); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Mileage reimbursement

Health insurance

Retirement plan

PTO & holidays

Job summary

Agrace, a nationally recognized nonprofit leader in hospice and palliative care, seeks a Homecare Social Worker to provide direct social work services, assessments, and plan of care for patients and families in Watertown, WI.

The role emphasizes patient and family-centered care, collaboration with the Interdisciplinary Team, and education on end‑of‑life issues, with on‑call rotations and community resource referrals.

Qualifications

• BSW required; MSW preferred.
• Current, unrestricted Social Work license in state of employment.
• One‑year paid medical social work experience.
• Valid driver's license, auto insurance, and access to a reliable vehicle.
• Must be at least 18 years of age.

Responsibilities

• Initial and ongoing patient/family assessments and advocacy.
• Collaborate with IDT to formulate and revise Plan of Care in EHR.
• Document education, interventions, and outcomes; monitor changes in condition.
• Provide patient/family education and resources for coping with terminal illness and bereavement.
• Participate in SW on‑call rotation and contribute to program activities.

Skills

Microsoft Office

Electronic Health Records

Confidentiality

Communication

Education

Bachelor’s in Social Work (BSW)

Master’s in Social Work (MSW)

Tools

Electronic Health Records (EHR)

Job description

Job Details: Job Location: Watertown, WI - Watertown, WI, Position Type: Full Time, Salary Range: Undisclosed, Travel Percentage: Driving, Job Shift: AM, Job Category: Health Care, Location: Watertown, WI

Full-time 1.0 FTE (40 hours/week) | Day Shift | Monday-Friday | 8:00 am - 4:30 pm

Includes on call and holiday rotations

Make a lasting impact with Agrace

Join Agrace, a nationally recognized nonprofit leader in hospice and palliative care. If you are a skilled Social Worker who values meaningful, patient-centered care, this is your opportunity to make a difference!

How You’ll Make a Difference (Essential Functions)

The Homecare Social Worker is responsible for patient and family satisfaction through the provision of direct social work services by conducting assessments, providing interventions, creating and updating the plan of care, communicating, and documenting. The provides patient and family centered care consistent with Agrace philosophy, goals, standards, regulations and policies.

Key Responsibilities

Initial and Ongoing Patient/Family Assessments

• Assess patient and family psychosocial, spiritual, grief and educational needs as part of the initial and comprehensive as per the patient’s individualized Plan of Care (POC).
• Advocate for patient/family goals.
• Coordinate transition planning in collaboration with the patient/family, homecare, and Interdisciplinary Team (IDT).
• Anticipate and respond to patient/family psychosocial, spiritual, resource, or grief needs. Round on patients.

Care Planning and Coordination

• Collaborate with IDT and patient/family to formulate, implement, and revise individualized Plan of Care (POC) in the electronic health record (EHR). The POC to include goals, interventions, education, discharge plan, etc.
• Read, understand, and follow POC. Document education, interventions, and outcomes in EHR.
• Intervene, document, and report significant changes in condition or unusual incidents to appropriate IDT member such as client abuse/neglect, suicidal intent, harmful coping mechanisms or violence, etc.
• Facilitate communication among patients, families, and Agrace staff.

Education, Intervention, and Resources

• Provide individual patient/family education and support regarding behaviors, emotions, and psychosocial adjustment to terminal illness, dying, and bereavement. Evaluate the effectiveness of education and adjust to meet needs.
• Provide appropriate education and interventions for patient/family based on clinical assessment and patient/family goals. Evaluate the effectiveness of interventions and adjust to meet needs.
• Develop and maintain knowledge of community, legal, Agrace, and hospice specific resources. Refer patients/families to resources. Act as patient/family advocate to obtain resources.
• Assist with Power of Attorney for Health Care (POAHC), Financial Power of Attorney, Living Will, and Guardianship including assistance with Power of Attorney capability and competency assessment.

Miscellaneous

• Participate in meetings to plan and evaluate patient/family services.
• Participate in SW on-call rotation.
• Participate in education and outreach.
• Participate in death visits, including assistance with post-mortem cares using safe body mechanics.
• Precept new staff and students.
• MSW may audit or oversee the work of BSW.

You Bring (Qualifications)

• Bachelor’s in Social Work (BSW), required; Master’s in Social Work (MSW), preferred.
• Current, unrestricted Social Work License in state of employment
• One‑year paid medical social work experience
• Valid driver’s license, auto insurance, and access to a reliable vehicle
• Must be at least 18 years of age
• Intermediate Microsoft Office skills
• Intermediate electronic health records skillsAbility to maintain confidentiality about patients, families, caregivers, staff, donors, and organizational
• intellectual property
• Ability to use proper body mechanics, safe patient handling, and standard precautions

Benefits

• Competitive salary with mileage reimbursement
• Health, dental and vision insurance for employees who are hired for 28+ hours per week (.7 FTE +)
• Retirement plans with employer matching
• Generous Paid Time Off (PTO) and holiday paid time off
• Comprehensive onboarding, mentorship, and career development

About Agrace

For more than 45 years, Agrace has been an innovator and leader in both caring for patients and their families, and in educating others about death, dying and grief. We are the largest hospice provider in Wisconsin. Well known for end-of-life care, Agrace also serves people across southern Wisconsin who are aging, seriously ill or grieving.

At Agrace we are strengthened by the unique experiences, cultures and traditions of our staff, patients and clients.

Together, we pursue a vision in whicheveryAgrace staff member is treated fairly, and every patient and client experiences the respectful, individualized care they need and deserve.

We foster a culture of belonging that celebrates people’s uniqueness and leads to meaningful, empathetic connections.

Agrace Health Inc. is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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