Care Coordination Master Social Worker

JOB SUMMARY / PURPOSE

The Masters Social Worker is responsible for performing social work assessments and interventions as needed for hospitalized and emergency department patients. The functions of the Masters Social Worker include: crisis intervention, patient/family intervention, high-risk screening, brief counseling, referrals for financial or other identified resource needs, arrange and facilitate family/patient representative meetings with the health care team as needed, arrange post-acute placement on complex discharges and engagement of appropriate agencies or community resources when high-risk patients are identified.

ESSENTIAL KEY JOB RESPONSIBILITIES

1. Providing developmentally appropriate care for all populations served: plan for the safe discharge and continuity of care, recognize and plan for the unique needs of all ages, the physically disabled, mentally ill, chronically ill, terminally ill, and vulnerable patients.
2. Advocacy and education: patient/family self-care management; patient/family health management education; bioethics referrals and management; physician, staff, and community education; case/care management/coordination education and training; risk management identification and referral. 
3. Psychosocial management: crisis intervention; psychosocial assessment/functioning; counseling support and referral; abuse/neglect/trafficking identification, assessment, and referral (partner, child, elder, etc.); family issues affecting care; coping/emotional adjustment; grief/bereavement support (individual and group); adoption, surrogacy, and safe surrender support, management, and resources; health/wellness promotion; substance abuse screening, management, and resources; psychiatric screening, management, and resources; staff support; assessing, addressing, managing, and resources related to social determinants of health (e.g. housing and food insecurity, transportation). 
4. Patient/Family Care Conferences: interdisciplinary care communication/coordination related to continuity/transitions of care planning and management. 
5. Continuity/Transition Management: As part of Care Management/Coordination team, facilitation of patient decisions and communications regarding post-acute care; professional responsibility for knowledge of community resources related to clinical social work scope of service and functions and social worker discretion; maintaining appropriate up-to-date resource lists; education for patients/families about availability of community resources; mental health service and support coordination; grave disability, palliative care/end-of-life, and hospice patient/family support, referrals, and management; interventions, management, and coordination of transition planning for psychosocially complex cases. 
6. Community Resource Coordination: life-care planning; expert consultation on health care resource management; team and patient education regarding various health-related insurance/support programs (e.g. CCS/Medicare/Medicaid/SSI); building and maintaining community relationships to address needs of patients experiencing homelessness and to meet other social determinants of health needs. 
7. Performance & Outcomes Management: in-depth understanding and application of federal/state/local regulatory agency guidelines, The Joint Commission standards, and other regulatory and accreditation requirements; implement evidence-based practices; support organizational financial performance, length of stay, cost per case, readmission prevention efforts and revenue cycle goals. 
8. Provide support and social work services to outpatients if directed by Care Coordination leaders. 
9. Participates in performance improvement teams and programs as necessary. 
10. Demonstrates behavior that aligns with the Mission and Core Values of the Organization. 
11. Responsible for completing required education within established timeframes. 
12. Adheres to all hospital policies, standards of practice and Federal or State regulations pertaining to their practice. 
13. Performs other duties as assigned.

Education and Experience:

Required:   Master’s degree from a school of social work accredited by the Council of Social Work Education.

1-Year Post-MSW experience or Social Work internship in a clinical or medical setting

Preferred:  Minimum 3-Year Post-MSW healthcare experience.

Required Licensure and Certification:

Washington: Licensed Social Worker Associate Independent Clinical,
Licensed Advanced Social Worker,

Licensed Social Worker Associate Advanced,

Licensed Agency Affiliated Counselor(MSW:WA)

In 2020, united in a fierce commitment to deliver the highest quality care and exceptional patient experience, Virginia Mason and CHI Franciscan Health came together as natural partners to build a new health system centered around the patient: Virginia Mason Franciscan Health. Our combined system builds upon the scale and expertise of our nearly 300 sites of care, including 11 hospitals and nearly 5,000 physicians and providers. Together, we are empowered to make an even greater impact on the health and well-being of our communities. 

CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.  

While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!

Sign on bonus available.