Social Worker - Phone-Based Advance Care Planning

Sioux Center Health; Sioux Center (IA); On-site; USD 40,000 - 61,000; Full time

Benefits offered by this job

PTO from day 1

Retirement matching up to 5%

Career development and mentorship

Job summary

Avera, a multispecialty health system based in Sioux Falls, SD, seeks a social work professional to coordinate Advance Care Planning across ambulatory clinics. The role focuses on patient goals, values, and end-of-life planning, with education, care coordination, and collaboration with providers and families.

You will lead ACP programs, support care transitions, and promote patient-centered decision making.

Qualifications

• Must have strong communication skills in patient and family discussions.
• Experience coordinating care across clinics, hospital and home care settings.
• Familiarity with advance care planning regulations and ethical considerations.
• Experience leading interdisciplinary teams in acute or ambulatory care.

Responsibilities

• Develops and maintains ACP programs across clinics, including standards and reporting.
• Facilitates ACP discussions with patients, families, and designated decision-makers.
• Collaborates with providers, care managers, social workers, hospice and other teams to identify eligible patients.
• Provides education and support on ACP principles and documentation to patients and staff.
• Establishes ongoing communication with clinics, hospitals, and community partners to ensure seamless care transitions.

Skills

Communication

Care coordination

Interdisciplinary collaboration

Problem solving

Education

Master's in Social Work

Active Social Worker license in state

Advance Care Curriculum Certification

3+ years in healthcare/settings

Tools

Epic care pathway build

Job description

Avera, a multispecialty health system based in Sioux Falls, SD, seeks a social work professional to coordinate Advance Care Planning across ambulatory clinics. The role focuses on patient goals, values, and end-of-life planning, with education, care coordination, and collaboration with providers and families.

You will lead ACP programs, support care transitions, and promote patient-centered decision making.