Pursue Your Calling.Advance Your Career.
HIGH RISK SOCIAL WORKER
Location: Nashua, NHDepartment: Case ManagementFacility: St. Joseph Hospital – Nashua, NHJob ID: 27446
Summary:
Provides and/or oversees the provision of appropriate and timely resources, interventions, and services for selected patients in the hospital. Collaborates with the interdisciplinary team of healthcare professionals involved in the plan of care for high-risk patients including, but not limited to, hospital-based Case Management and clinical staff, the patient's primary provider, High Risk RN Care Coordinator, practice team members and community partners. Ensures that plans are focused and effective which helps patients to connect with and utilize a full range of medical, community and other services available.
Essential Duties and Responsibilities
• Supports and promotes the mission and values of Covenant Health Ministry.
•Provides assessment of patient Social Determinants of Health which may include: o Living situation – environment, safety, abuse & neglect o Risk to self or others o Substance misuse o Financial resources o Behavioral health history o Barriers to care o Cultural issues o Coping style o Life transition o Understanding of illness/disease process(es) o Primary Care Provider o Advance Directives – DPOA, Guardianship, etc.
• Provides psychosocial evaluation/assessment of patient family/caregivers
• Assesses learning and coping styles, cultural issues, family resources and readiness to participate
• Makes recommendations for direct service and/or referral for a wide range of community resources, based on assessment of patient/family needs
• Acts as a patient advocate to ensure patient/family receives access to services.
• Readmission review and interventions placed to prevent further readmissions
• Provides direct intervention to patients/families based upon the assessment, need and patient consent
• Provides financial information for patients/families
• Facilitates Medicaid applications and/or other financial assistance from the community as needed by patient/family
• Acts upon referrals for Social Work within one business day
• Works collaboratively and effectively with the interdisciplinary team and community partners
• Assists with provision of seamless transition across the continuum of care
• Facilitates support groups for the community according to identified needs
• Maintains effective working relationships with community partners
• Facilitates Advance Directives as requested
• Conducts patient/family meetings
• Assists the patient/family to understand and accept medical recommendations and supports patient/family with decisions
• Facilitates team conferences, discharge planning and family conferences
• Meets patients at practices, hospital, community and/or in home as needed
• Documentation is timely, precise, and relevant
• Demonstrates ability to organize workload and set appropriate priorities based on patient’s medical needs, preference, availability of service, and patient/family compliance.
• Maintains current knowledge of organization’s policies and procedures.
• Maintains clinical competence in relation to social work practice in Hospital.
• Maintains/enhances professional development and personal growth required to perform as social worker and to fulfill organizational requirements.
• Participates in peer review with team members
• May provide clinical supervision to undergraduate and/or graduate level social work students in field work placement with St. Joseph Hospital.
• Acts as a patient advocate to ensure patient/family receives access to services.
• Develops and implements process improvement activities on assigned units.
• Identifies opportunities for improvement in hospital-wide systems for the delivery of social services.
• Identifies high risk patients & families and makes referrals to Quality and Risk Management.
• Stays current with DNV & CMS regulations as well as State regulations that pertain to Social Services
• Assists in writing policies, memos, and patient/family education material as assigned.
• Assists in the planning and development of programs and special projects.
• Serves on assigned hospital committees.
• Performs various assignments as requested by the Director of Care Coordination.
• Other duties as consistent with this role. Job Requirements Job Knowledge and Skills
• Experience and comfort working with adult patients >18 who have complex medical and/or psychiatric problems.
• Ability to work with families of diverse patient populations
• Ability to assist patients/families understand and access resources
• Strong assessment and organizational skills
• Ability to advocate/negotiate for patients through systems
• Good organizational skills
• Demonstrated ability to communicate effectively verbally and in writing
• Strong interpersonal skills enabling effective team collaboration
• Maintains confidentiality
• Ability to work remotely as needed
Education and Experience
• MSW required
• LICSW preferred
• Knowledge of end-of-life issues preferred
• Knowledge of community agencies and resources preferred
• Minimum of two years’ experience in a health care setting preferred An equivalent combination of education and experience which provides proficiency in the areas of responsibility listed above may be substituted for the above education and experience requirements. Working Conditions/Physical Demands Must possess the physical and mental abilities to perform the tasks normally associated with this position that involves a combination of sitting, standing, walking, bending, stooping, and reaching. Lifting/carrying frequently up to 35 pounds, and occasionally up to 50 pounds. Some stress related to high level of responsibility for quality care.
Covenant Health Mission Statement
We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.
Our Core Values:
•Compassion
We show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.
•Integrity
We promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.
•Collaboration
We work in partnership, dialogue and shared purpose to create healthy communities.
•Excellence
We deliver all services with the highest level of quality, while seeking creative innovation.
St. Joseph Hospital, Nashua, N.H.
We have been serving the local community since 1908. Our main campus is in the heart of Nashua, N.H., and we have satellite campuses in Hudson, Merrimack and Milford. Our 208-bed hospital combines the latest technologies with personalized medicine. Living and working here, you’ll be part of our tight-knit community and experience a quality of life you can’t get elsewhere.
Life in New England
Every season brings a new reason to love New England’s scenic and cultural treasures. Hikers, bikers and skiers find their bliss among the rolling hills and rocky peaks of some of the country’s prettiest landscapes, all within 50 miles of Boston. In fact, New Hampshire has consistently ranked one of the top states in the U.S. to raise a family.
Competitive Benefits Package
We create an outstanding work environment for our physicians, nurses and employees. Health coverage, tuition reimbursement, an Employee Assistance Program and community volunteering activities are just some benefits for our team members. A competitive compensation and benefits package helps you and your loved ones stay healthy, meet your financial goals and thrive professionally and personally.
St. Mary’s Health System, Lewiston, Maine
St. Mary’s Health System was founded in 1888 by the Sisters of Charity of Saint-Hyacinthe. Today, the integrated medical system includes an acute care community hospital, a group of primary care and specialty providers, urgent care and emergency department, plus an extensive complement of outpatient specialty, behavioral and mental health services. Living and working here, you’ll be part of our talented and compassionate caregivers serving Androscoggin County.
Life in New England
Every season brings a new reason to love New England’s scenic and cultural treasures. Hikers, bikers and skiers find their bliss among the rolling hills and rocky peaks of the country’s prettiest landscapes in the Appalachian range. The twin cities of Lewiston-Auburn are the second-largest metro area in Maine and just 30 miles north of Portland. The region offers a reasonable cost of living and some of the safest neighborhoods in the country.
Competitive Benefits Package
We create an outstanding work environment for our physicians, nurses and employees. Health coverage, tuition reimbursement, an Employee Assistance Program and community volunteering activities are just some benefits for our team members. A competitive compensation and benefits package helps you and your loved ones stay healthy, meet your financial goals and thrive professionally and personally.
St. Joseph Healthcare, Bangor, Maine
Founded in 1947 by the Felician Sisters, St. Joseph Healthcare comprises an acute care hospital and a range of inpatient and outpatient services meeting the community’s evolving needs. Our more than 800 dedicated employees encompass our Mission through compassion, supporting a patient’s mind, body and spirit. Living and working here, you’ll be part of our tight-knit community and experience a quality of life you can’t get elsewhere.
Life in New England
Rated the No. 1 small city in the U.S. in the millennium edition of Places Rated Almanac, Bangor is in the heart of Penobscot County. It allows excellent access to everything the state offers, including scenic coastlines and beaches, camping and hiking, and charming small towns. The state provides a reasonable cost of living and some of the safest neighborhoods in the country
Competitive Benefits Package
We create an outstanding work environment for our physicians, nurses and employees. Health coverage, tuition reimbursement, an Employee Assistance Program and community volunteering activities are just some benefits for our team members. A competitive compensation and benefits package helps you and your loved ones stay healthy, meet your financial goals and thrive professionally and personally.
Why Covenant Health?
Covenant Health and our family of organizations have been healing and transforming lives for more than a century, and we continue to be unwavering in our Mission. In addition to providing an environment that is both challenging and rewarding, we offer:
- Mission driven organization and colleagues
- Numerous locations across New England and part of Pennsylvania, including some remote and hybrid positions
- Highly competitive salaries that are market-based and experience rated
- A comprehensive and flexible benefits program designed to protect and enhance your health and financial security
- Additional benefits like wellness programs, earned time off, extended sick leave, leaves of absence, family and medical leave
- Professional development and education opportunities
- A healthy and effective balance between your work and life responsibilities