At Houston Methodist, as a Social Worker PRN, this position comprehensively provides compassionate, clinical social work, psychosocial assessments, diagnosis and treatments, and complex discharge planning to patients and their families of a targeted patient population on a designated unit(s). In collaboration with physicians and the interprofessional health care team, this position sensitizes other health care providers to the social and emotional aspects of a patient's illness to collaboratively facilitate efficient quality care and achievement of desired treatment outcomes and affect positive patient and family outcomes. The Social Worker PRN position uses case management skills to help patients and their families address and resolve the social, financial and psychological problems related to their health condition and holds joint accountability with case manager, assuring that psychosocial and continuing care issues are addressed and treated as needed across the continuum of care.
PEOPLE ESSENTIAL FUNCTIONS- Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner, listens and responds to the ideas of others. Uses therapeutic communication to establish a relationship with patients and families and communicates the discharge plan, facilitating transitions and hand-offs. Supports patients and families in clinical or ethical issues.
- Provides staff education specific to patient populations and department processes. May serve as a preceptor and mentor to new employees. Identifies, leadership opportunities for professional growth of self and peers.
SERVICE ESSENTIAL FUNCTIONS- Serves as a hospital/post acute-based leader for comprehensive case management activities including assessing high-risk patients and leading team to identify at-risk patients, participating in daily Care Coordination rounds, and identifying and leading resolution to barriers of efficient patient throughput. Completes full assessment based on the social work assessment, addressing solutions of social determinants which is accomplished by patient/family interview, review of the medical record including previous episodes of care, H&P, lab and other test results/findings, plan of care, physician orders, nursing and progress notes. Uses advanced knowledge and clinical expertise and screening tools to identify need for case management and/or social work intervention.
- Addresses and manages conflict associated with a comprehensive psychosocial treatment plan utilizing appropriate clinical social work diagnoses, treatments and interventions, including crisis intervention, brief individual, marital and family therapies, and patient, family and caregiver groups. Maintains ownership of the psychosocial component, assessments, diagnosis and treatment, of the discharge planning process on assigned units. Assists with screening, identification, diagnosis, management and treatment of victims of abuse, neglect, and domestic violence and of mental health and/or substance abuse problems in patients and family members.
- Establishes mutual educational goals with patient and family, providing appropriate resources, incorporating planning for care after discharge. Provides education to physicians and other interdisciplinary team members on mutually identified goals of care and uses knowledge of levels of care, working with patient and family, to ensure discharge disposition is the appropriate level and facilitates transfers.
- Uses knowledge for different levels of care, working with patient and family, to ensure discharge disposition is to the appropriate level and facilitates transfers, Provides brief, goal-directed counseling services to assist patients/families to cope more effectively with the transition.
QUALITY/SAFETY ESSENTIAL FUNCTIONS- Consistently documents to reflect completed patient screening/assessment and reassessment upon admission and concurrently as needed. Modifies care based on continuous evaluation of the patient's condition, demonstrates problem-solving and critical thinking, and makes decisions using evidence-based analytical approach. Considers variables that impact treatment plans including diagnosis of emotional, social, and environmental strengths and problems related to their illness, treatment and/or life situation.
- Consistently reviews the patient for opportunities for care facilitation and needs for discharge planning. Works with case manager for routine discharge and anticipates/prevents and manages/elevates emergent situations. Specific focus given to discharge plan and elimination of psychosocial barriers.
- Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care through effective patient handoffs
FINANCE ESSENTIAL FUNCTIONS- Completes timely and thorough assessment on all unfunded patients to identify community resources required for effective transition by demonstrating an effective community resource knowledge base and the judgment/ability to effectively select and coordinate available resources, including referrals to regulatory agencies, i.e. CPS/APS.
- Identifies, obtains and utilizes alternative resources to fill gaps in established community resources.
- Guides discharge planning activities for assigned patients and collaborates with the case manager and other members of the interprofessional health care team, as well as patient and family by intervening and coordinating cost effective complex discharge planning outcomes and decreased length of stay
GROWTH/INNOVATION ESSENTIAL FUNCTIONS- Provides education to hospital physicians, nurses, and other healthcare providers on community resources and psychosocial impact on care needs.
- Identifies areas for improvement based on understanding of evidence-based practice literature.
- Identifies, initiates and leads evidence-based practice/performance improvement projects based on observations by offering solutions and participating in unit projects and activities.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
EDUCATION- Master's degree in social work from accredited university
WORK EXPERIENCE- Two (2) years of social services experience in a hospital system setting
LICENSES AND CERTIFICATIONS - REQUIRED- LMSW - Licensed Medical Social Worker - State Licensure
LICENSES AND CERTIFICATIONS - PREFERRED- CCM - Certified Case Manager AND
- ACM - Accredited Case Manager (ACMA) AND
- ACM - Accredited Case Manager (NBCM) OR
- LCSW- License Clinical Social Worker - State Licensure
KNOWLEDGE, SKILLS, AND ABILITIES- Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
- Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
- Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
- Knowledge of community resources and health care financial and payer issues, and eligibility for state, local and federal programs
- Maintains individual competencies around critical Social Work functions including; payor rules and regulations, psycho-social assessments and discharge planning methods.
- Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
- Well versed in computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)
- Critical thinking, collaboration, negotiation, and mediation skills
- Time management and prioritization skills
- Adherence to the clinical practice standards set forth by NASW practice standards for healthcare settings and more specifically in hospitals and medical centers.
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area Yes
Company Profile:
Houston Methodist Willowbrook Hospital is a Magnet-recognized, not-for-profit, faith-based hospital that serves the growing Northwest Houston community. With 358 licensed beds, Houston Methodist Willowbrook is committed to providing quality, cost-effective health care in a compassionate environment for a full range of services, including emergency care, cardiology, orthopedics and sports medicine, comprehensive women’s services, neurology and neurosurgery, oncology, and primary and general medicine.
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.