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Social Worker, MSW - MNS ISP

Company: Cedars Sinai
Location: Long Beach
Posted on: May 9, 2022

Job Description:

The Clinical Social Worker, MSW is responsible for the development, planning, implementation, and evaluation of all social service-related interventions for corresponding Department/s. Is responsible for identifying patients who have psycho/social needs on an inpatient or outpatient basis. Is responsible for developing patient care goals and treatment plans as agreed upon by the patient's care team. Is also available to physicians and nurse case managers as a consultant for those patients with complex psychosocial needs and advance care planning. Primary Duties and Responsibilities Evaluate and implement with the assistance of the program director and medical director a high touch social service program for patients with psycho/social issues. With a particular focus on seniors, catastrophic, and chronically ill patients Development: Social Service documentation tool/template in EMR for Palliative consults, family counseling, and group sessions Implementation: triage patients with the Supportive Care Team; assist in the coordination of patient care delivery, including DPA/POSLT Implement transitions of care between inpatient Supportive Care Services and continued outpatient follow up Initiate team care conference to include patient, family and care providers Evaluation: evaluate caseload daily and assess achievement of long and short term goals; modify goals with providers and care team based upon patient outcomes; compile and present statistics and reports relating to patient outcomes; document findings in the patients EMR Communication: provide follow up and outcome communication to the referral source, IE, PCP, family member, case manager, home health personnel, community social worker, Health Plan, etc. Assist in long term planning for patients transitioning to an institutionalized setting Assist in the arrangement of community resources (i.e. meals on wheels, transportation services, adult daycare, and info-line Assist in long term planning for patients transitioning to an institutionalized setting Provide alternatives for patients requiring specific services while lacking insurance coverage Act as a liaison to Population Health department in regard to chronic disease state management programs Participate in advanced care planning initiatives

Keywords: Cedars Sinai, Long Beach , Social Worker, MSW - MNS ISP, Healthcare , Long Beach, California

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