Title: Medical Social Worker Job Summary Provides coordinated care in the home to patients of all age groups and performs psychosocial assessments, analysis, counseling, and referrals to meet the needs of the patient and family. Participates in the coordination of care. Job Qualifications Masters or doctoral degree from an accredited program in social work. Certification. Current driver's license. One year of experience as a medical social worker in a healthcare setting. Working knowledge of community resources. Good interpersonal skills. Proof of current CPR certification. Transportation: Reliable transportation and valid auto liability insurance. Environmental and Working Conditions Works in patients' homes in various conditions; possible exposure to infectious diseases; ability to travel locally; some exposure to unpleasant weather. Physical and Mental Effort Prolonged standing, walking, and sitting required. Requires working under some stressful conditions to meet deadlines and patient and family needs, and to make quick decisions and resource acquisition; meet patient and family psychosocial needs. Essential Functions Performs ongoing clinical assessment of home health patients to identify psychosocial, financial, environmental, and community resource needs as evidenced by the POC, documentation, clinical records, case conferences, and community resource referrals. Develops and evaluates the plan of care in partnership with the patient, representative (if any), and caregiver(s). Accepts clinical assignments that are consistent with education and competence to meet the needs of the patients. Provides services that are ordered by the physician as indicated in the plan of care, including patient, caregiver, and family counseling, and patient and caregiver education. Prepares clinical notes. Uses effective interpersonal relations and communication skills; facilitates the use of these skills by other team members to achieve desirable outcomes. Communicates with all physicians involved in the plan of care and other healthcare practitioners related to the current plan of care. Meets mandatory continuing education requirements of the Agency and licensing board. Demonstrates commitment, professional growth, and competency by maintaining a working knowledge of public and private eligibility standards and requirements. Promotes the Agency philosophy and administrative policies to ensure quality of care. Collaborates with the interdisciplinary team to promote coordination of patient care. Participates in the Agency's QAPI program. Participates in the Agency sponsored in-service trainings. #J-18808-Ljbffr