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Social Worker - MSW, Contingent
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Part-time
- 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.
- In collaboration with patient, family a primary care provider, develops plan to address and manage issues which influence health care utilization including services for home as well as facilitates hospital-to-hospital transfers, hospice, extended care facility, acute rehabilitation and long term care facility placement.
- Refers patients to designated community agencies or resources for financial assistance, counseling, mental health and substance abuse follow up, and other support services.
- Conducts continuity of care planning for assessing needs support services for home as well as facilitates hospital to hospital transfers, hospice, extended care facility, acute rehabilitation and long term care facility placement.
- 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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