CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Works collaboratively with physicians, staff and other health care professionals within his/her Division to coordinate the care and service of selected patient populations across the continuum within the acute care setting. The role works collaboratively with patient, family, physician and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The Social Worker supports responsibility for an interdisciplinary process to meet the psychosocial and transitional needs of the patient and family. The Social Worker is knowledgeable about various age-related care protocols and functions within their scope of practice. The Social Worker is an integral member of the health care team as well as the Divisional Care Management team. In addition, the position collaborates with the Divisional Care Management team on system-wide quality improvement/performance improvement initiatives.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Conducts a psychosocial assessment on identified priority patients in collaboration with family.
2. Outline available strategies and services to assist in addressing psychosocial care needs, and to make recommendations as appropriate.
3. Specialized screening tools may be used for the assessment such as Depression screen, Anxiety screen, Substance Abuse screen, Health Literacy screen, Mental Status screen, and Social Support screen as well as other specialized screens and evaluative tools.
4. Develops individualized psychosocial case plans in collaboration with Case Manager -Acute Care based on assessment and in conjunction with other members of the Care Management team.
5. Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality.
6. Provides crisis interventions and psychosocial counseling services to restore patients and families to optimum social and psychological health based on their strengths and use of available resources.
7. Provides factual information and materials to patients/families and others regarding programs end stage illnesses.
8. Makes referrals promptly to appropriate agencies for services suitable to meet patients’ needs.
9. Screens patients for financial assistance and helps clarify insurance benefits. Supports patients and families in their efforts to address and cope with the economic stress brought on by serious illnesses. Knowledgeable regarding financial resources.
10. Assists patient and family in enrollment in needed programs and services.
11. Assesses need for services through multidisciplinary rounds on patients and collaboration with physicians and other interdisciplinary team members.
12. Consults with outside agencies in the delivery of individual/community care necessary to meet identified and agreed upon goals.
13. Arranges for and coordinates a broad spectrum of discharge planning services for patients during their hospitalization.
14. Collaborates with patient/family, physicians, and care management staff to determine patient’s post-discharge needs and plans.
15. Provides patient/family with information on options/resources available and strategies for utilizing resources. Assists with all necessary referrals.
16. Other duties as assigned.
Required Licensure and Certifications:
Required Minimum Knowledge, Skills and Abilities:
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