Medical Social Worker

We are searching for a Medical Social Worker, someone who works well in a fast-paced setting. In this position, you’ll assist patients and their families or caregivers in making psychosocial adaptations specific to their medical diagnosis, while facilitating eligibility determination for social programs and funding resources. Apply optimal utilization of health care services and community resources in accordance with the principles of human growth and development. You'll assess, plan, implement, deliver, monitor and evaluate the options and services required to address a patient's individualized plan of care in collaboration with the interdisciplinary team to achieve discharge goals.

Think you’ve got what it takes?

Job Duties & Responsibilities

Conducts a psychosocial assessment, evaluating patient/family psychosocial risk factors and reassessing the patient’s plan of care, adjusting goals and interventions as needed as evidenced by documentation in the medical record and/or team observation/feedback

Screens for depression and suicidal ideation, completes a mental health assessment as needed and takes appropriate steps based on outcome including referral to psychiatry services, mental health facility, court order for involuntary commitment, safety plan or referral to community resources

Communicates recommendations with the patient, family and team to support a collaborative family centered approach and ensures effective communication through patient handoffs with interdisciplinary team as evidenced by documentation in the medical record and/or team observation/feedback

Develops an action plan with the patient, caregiver or family and team taking into consideration variables that impact the patient’s plan of care including social, emotional, physical or environmental factors as evidenced by documentation in the medical record and/or team observation/feedback

Supports patient/family or caregiver with resources related to end-of-life decision making and provides support for complex family dynamics, assessing for barriers to care and discharge and intervening to de-escalate non-productive behavior as evidenced by documentation in the medical record and/or team observation/feedback

Engages and empowers patient/family or caregivers in problem solving anddecision-makingg regarding health care decisions as evidenced by documentation in the medical record and/or team observation/feedback

Evaluates and selects appropriate community resources based on psychosocial assessment and supports referrals, independently assessing need for gap resources and making additional recommendations as evidenced by documentation in the medical record and/or team observation/feedback

Provides case management for psychosocial continuity of care as evidenced by documentation in the medical record and/or team observation/feedback

Completes maltreatment assessment and provides intervention in cases involving abuse or neglect and contacts protective services as appropriate and in accordance with state law as evidenced by documentation in the medical record and/or team observation/feedback

Facilitates timely discharge by participating in team meetings, family meetings and unit rounds to address social, emotional, physical and environmental barriers as evidenced by attendance records and/or team observation/feedback

Collaborates with care coordination and outpatient professionals to ensure patients and families receive necessary information, resources and continuity of care

Provides transition services for patients with chronic conditions including education, resource identification, preparation for adult living skills and assistance with advance directives

Utilizes quality improvement processes to identify opportunities for improvement, evaluate programs and measure outcomes as evidenced by leadership observation

Participates in performance improvement initiatives and supports patient safety and satisfaction efforts as evidenced by leadership observation

Pursues professional development through continuing education, implements changes, provides mentorship and serves as a resource to interdisciplinary team members regarding medical and legal reporting guidelines

Skills & Requirements

Master's Degree Social Work required

LMSW - Licensed Master Social Worker by the Texas Behavioral Health Ex Council (TBHEC) or LCSW - Lic Clinical Social Worker by the Texas Behavioral Health Ex Council (TBHEC) required