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Job Description

Job Summary:

  • To work collaboratively with members of an interdisciplinary team in order to assist patients and families with complex psychosocial needs.
  • These interventions may include, but are not exclusive to: alternate site coordination, discharge planning, addressing all forms of identified abuse/neglect, adoption, substance use disorders, assisting with end of life decisions, providing appropriate referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers).

Duties and Responsibilities:

  • Conducts psychosocial assessments with patient and or family to assist with identified psychosocial needs or who may be identified to require an alternate site of care post discharge and executes a plan.
  • Communicates with alternate sites of care and/or community agencies in an effective and timely manner, to best address the patient’s needs.
  • Completes and documents the assessment and plan in the electronic medical record, accurately reflecting the patient’s current condition, situational factors, transition of care needs and psychosocial imperatives.
  • Provides consultation and resources to members of the healthcare team.
  • Responsible for maintaining relevant and current knowledge of community resources.
  • Participates or assists in department, regional, or statewide stakeholder committees, projects etc., as assigned/requested.
  • Develops and maintains current knowledge of federal and state regulations as they pertain to role.

Requirements:

  • Required Master’s Degree Social Work.
  • Experience in individual, family assessment, crisis intervention, grief and loss counseling, and discharge planning preferred Preferred.
  • MSW or LBSW.
  • LIC-Master Soc Work LTD – STATE_MI State of Michigan Upon Hire required.
  • LIC-Driver’s License – STATE_MI State of Michigan Hospice and Home Care Upon Hire required.