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Social Worker - Inpatient, Contingent
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Part-time
- Responsible for coordinating the health care plan (including discharge plans from the acute setting and transitions of care to the post-acute care network) for assigned patient populations through the use of care plans, critical pathways, managed care and collaboration with all members of the health care team.
- Evaluates and gather data from the patient, family, outpatient supports and other collateral sources (including the primary care provider) regarding plan of treatment and available resources, and develops an appropriate intervention plan.
- Refers patients to designated community agencies or resources for financial assistance, counseling, mental health and substance abuse follow up, and other support services.
- Refers to Skilled Home Care, Durable Medical Equipment vendors and other appropriate referral sources to assist patient in achieving a safe, optimal continuing care plan.
- Advocates, educates, and facilitates resolution of patient rights, ethical and legal issues such as advance directives, end of life decisions, guardianship, etc.
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