Social Worker Mobile Crisis Outreach Program

SHIFT : Full Time ‐ Evenings 11AM ‐ 7 PM

Every other Weekend required

Job Responsibilities

Participates and implements discharge planning activities for complex patients in order to ensure a timely discharge and to provide appropriate linkage with post‐discharge care providers. Receives referrals for complex patient problem resolution from Care Mangers and other members of the healthcare team.

Maintains accountability for the completion of the transition of the patient to the next level of care for assigned cases. Revises plan as needed. Updates patient / family as needed. Proactively identifies and resolves delays and obstacles to discharge in conjunction with Nurse Care Manager and Associate Care Manager.

Maintains a working knowledge of financial reimbursement methodology for all payers to identify any financial risk / needs for acute care admission as well as post‐discharge placement.

Maintains knowledge of community resources and keeps a referral directory with updated information of available services and contact information.

Assesses the patient's and family's psycho social risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.

Provides intervention and finds resolution for cases suspicious of adult / child abuse / neglect, domestic violence, sexual assault; requiring guardianship temporary / permanent, foster care, adoption, mental health placement, advance directives, child protection.

Provides supportive counseling and crisis intervention counseling for patients and families as needed.

Position Requirements

Minimum Required :

Masters in Social Work (MSW)

NYS Licensed Master Social Worker (LMSW) or limited permit (Note : Social Workers within the Clinics must have current NYS Social Work License; not a Limited Permit).

Preferred :

3 years post graduate experience

Work Environment

ENVIRONMENTAL CONDITIONS :

• All work is performed in an office or on hospital units that requires working in close quarters with other employees. The areas are air conditioned as well as heated. Not exposed to environmental or toxic hazards.

PERSONAL PROTECTIVE EQUIPMENT :

Age of Patients Served

HIPAA Roles‐Based Access to Patient Information