Medical Social Worker/Discharge Planner
Company: American Advanced Management, Inc
Posted on: June 10, 2021
Our mission is to provide all of our patients with the highest
quality long term acute care and transitional care given in the
state of California. We are committed to upholding a culture of
shared values that provide dignity, growth, and value to our
patients, employees and physicians.
We believe our hospital will provide a variety of quality
services that will not only be an asset to the community but a
distinct benefit to the surrounding acute hospitals.
It is our vision to become world recognized for our outstanding
specialty and long term acute services accomplished through
quality, innovation and leadership.
The Long Term Acute Care (LTCH) Division of Sonoma Specialty
Hospital is designed to provide care of medically complex patients
who have experienced catastrophic illness and/or multi-system
failure and are in need of intense rehabilitation services and an
extended stay in an acute care setting. These patients usually come
directly from a Short Term Acute Care Hospital (STCH) and are in
need of vent weaning and acute rehabilitation services for a longer
period of time to recover and return to their optimal level of
health. The average length of stay (ALOS) of these patients is a
range of 25-35 days which is a longer than average stay at a Short
Term Acute Care Hospital. Care for these types of patients is
provided by RNs, Respiratory Therapists, Wound Care Nurses,
Physical Therapists, Occupational Therapists, and Speech
Therapists. Also a collaborative team of specialty physicians,
psychologists, dieticians, and social workers will focus on an
individualized goal for each patient to recover and reach their
independence and optimum level of health.is a missing piece in the
continuum of care within the health care system.
The Social Worker is responsible for identifying patient and
family psychosocial, emotional and cultural needs and priorities
for care through assessment, care planning, clinical interventions,
education and evaluation of outcomes, adjustment to illness (acute
or chronic) and discharge needs. The position will collaborate with
Nursing unit, Physician, NP, Pharmacy and other care providers to
address the indigent requirements, needs for medications, other
resources, and referral processes for entitlements. Through
documentation and oral communication, essential information is
shared with the health care team members. Works in coordination
with LCSW with regard to social services needs of our patient
Coordinates policies and procedures, staff education and
performance improvement. Maintains performance improvement
activities within the department and participates in QPI
ESSENTIAL JOB FUNCTIONS/ RESPONSIBILITIES
- Collects key psychosocial, emotional and cultural information
from patient, family, community agencies and other professional
disciplines as part of social work assessment.
- Demonstrates knowledge of the principles of growth and
development over the life span and the skills necessary to provide
age appropriate interventions to the patient.
- Develops a psychosocial and discharge plan, mindful of long
term needs, support system, environment, and financial
- Provides community resource information and referrals for
patients and families, including those requiring assistance in
meeting health care services/programs/entitlements
- Provides appropriate counseling and support of patients and
family in the acceptance of medical condition, treatment, prognosis
and needs after discharge.
- Facilitate family conferences and/or mediation related to
patient care needs, medical condition or treatment. Includes health
care and others as determined.
- Assists physician and other health care professionals in
understanding significant social, emotional, and cultural factors
related to patient illness or disease process.
- Assures that social service/discharge planning activities are
integrated and coordinated within the hospital system by effective
communication at all levels.
- Develops, implements, and maintains policies and procedures and
forms related to Social Services, Discharge Planning,
- Treats patients and their families with respect and
- Communicates appropriately and clearly to Nurse Manager,
co-workers and physicians.
- Maintains a good working relationship both within the
department and with other departments.
- Documentation meets current standards and policies.
- Manages and operates equipment safely and correctly.
- Demonstrates an ability to be flexible, organized and function
under stressful situations.
- Five years of active social work services required.
- Two years of experience as a Medical Social Worker in an acute
hospital or LTACH preferred.
- Clinical experience with geriatric, or terminally ill
- Organization and coordination of resources.
- Master's Degree in Psychology or Social Work.
- Current BLS certification preferred.
Keywords: American Advanced Management, Inc, Santa Rosa , Medical Social Worker/Discharge Planner, Other , Sebastopol, California
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