The Social Worker Home Visitor ' Healthy Beginnings provides professional services to clients and their families eligible for the Healthy Beginnings Services in order to meet identified psychosocial, emotional, financial and environmental needs. The social worker provides psychosocial assessments, supportive counseling, emergent crisis intervention appropriate to setting, financial resource information, environment enhancements, advance directive planning and referrals to community agencies for clients and their caregivers/families in the client's home, mobile health clinic (MHC), or other settings. Using an interdisciplinary team approach, the social worker ensures clear communication and helps to facilitate care transitions. The social worker identifies and implements interventions at the individual and systemic levels and provides expertise to high risk clients across the continuum. The social worker works collaboratively with the multi-disciplinary team to support the RN performing at the highest level of their license in addition to maximizing the social worker's specialized training to address complex cases. Social Services are provided as part of a collaboration with interdisciplinary teams in adherence to the NFP model, and to policies, procedures, guidelines, and standards of NFP and of the Carle Health System.Involves client and family in case planning decisions.Provides social work intervention to clients and their families eligible for the Healthy Beginnings and/or Mobile Health Clinic services.Helps to facilitate care transitions, referrals to scoial services, and other specialits when needed.Keeps the director/manager informed of problematic cases, especially those involving legal or risk management issues.Provides assistance and advocacy to clients in obtaining financial resources and government entitlements.Develops and maintains tracking system of social services referrals /outcomes.Provides information and counseling for advance directives and health care power of attorney.Provides social work intervention to patient/families eligible for the NFP Program.Responds to referrals from healthcare team members to identify available services for case specific needs.Collaborates with nurse home visitors / supervisors / mobile health clinic staff to meet the needs of high risk populations.Details (direct or incidental) possible to enhance service/care is communicated across service lines and among disciplines.Documents all client interactions, significant observations, interventions, and actions taken in the client's medical record in an appropriate and timely manner.Formulates, develops, and implements a plan utilizing appropriate social work interventions. Provides education and counseling to clients and families around issues related to adaptation to the client's illness and/or life situation. May utilize crisis intervention, brief and long-term individual, group, and family therapies.Facilitates education/training modules to assist RN staff managing basic social work needs.As requested/required, participates in community coalition in support of NFP as well as promotes public awareness ofHealthy Beginnings Services and the Mobile Health Clinic.Develops and maintains community relationships to support client referrals.Assesses physical, emotional, social, spiritual, and environmental needs of clientsand their families as they relate to the NFP domains.Assists clients and their families in establishing goals and outcomes through therapeutic relationships by providing education, support, and referral resources.Consults and collaborates with other professionals involved in providing services to women and families.

The Home Services Social Worker identifies the psychosocial needs of patients and families through assessment. Social work interventions range from resource support identification and acquisition (including community support, financial and environmental enhancement) to short term counseling and emergent crisis intervention. Social Services are provided as part of a collaboration with interdisciplinary teams. Hours may vary depending upon census and program need.Provide psychosocial assessments of patients and families to identify emotional, social, and environmental strengths and problems related to their diagnosis, illness, treatment, and/or life situation.Captures all legitimate revenue; conservative in expense and resource use yet provides appropriate service and supplies to patients.Develops a bereavement plan of care to address family member/care giver needs.Interprets and communicates pt/family faith and culture traditions. Identifies and communicates when spiritual/religious beliefs may impact the physical and psychosocial care provided by other team members.Documents recert and discharge assessments which accurately reflect change in patients status and declines/improvements realized in comparison with initial assessment elements.Educates patient and family members in a manner that overcomes barriers; matches their learning capabilities and meets fundamental needs.Investigates and applies payer specific Commercial Hospice Benefits to optimize treatment opportunities.Visit notes and orders are completed and transmitted in a timely manner according to policy. Corrections to care plans are entered and transmitted according to time line.Documents psychosocial patient/family assessments, financial assessment and MSW interventions within patients' electronic medical record.Implements social work plan that results in: a) enhanced strength of family systems, b) patient/family/caregiver utilization of community resources, c) maximization of medical benefits, d) enhanced environment for care delivery, e) dignity for the dying patient, f) maximized patient/family coping skills, g) support for patient/family cultural beliefs and values. Evaluates effectiveness of social work plan of care and modifies intervention as indicated.Facilitates and supports patient decisions and communication of self-determined life care decisions.Provides care according to plan of care/orders. Develops social work plan of care in collaboration with IDT.Practices in a manner sensitive to the needs of patients and families. Daily practice and documentation are evidence of understanding of palliative/comfort philosophy and approach (versus aggressive/curative treatment).Identifies and responds to indicators of imminent death, addresses patient/family needs at time of death.Demonstrates understanding of Medicare Hospice Benefit including benefit eligibility, qualification for admission, election process, certification, recertification, transfer, non-recertification and revocation.Utilizes Memorial Funds appropriately and submits documentation in a timely manner according to policy.Demonstrates understanding of Medicare Home Care benefit including eligibility, qualification for admission and services available.Complete or assist and educate the patients/caregivers on advanced directives, including living will, HCPOA, and POLST forms.Assist with Transportation barriersAssistance with Referrals for lack of access to food, clothing, assistance with power billsMake referrals for help in the HomeAssistance with Applications (Medicaid, Community Care, SSDI)Make Elder Abuse/Neglect Referrals

The Radiation Therapist applies ionizing radiation to the patient in accordance with the prescription and instructions of the Radiation Oncologist.Accurately delivers the planned course of radiation therapy with minimal supervision. Verifies patient information and prepares the treatment room and equipment.Monitors patient's condition while undergoing treatment, recognizing signs of treatment complications and alerting the physician or nurse if needed.Explain procedure to patient, means of communication during treatment, and procedure to follow if emergency arises during treatment. Reinforce Radiation Oncologist's advice to patient regarding reactions to treatment and their care.Perform quality assurance checks on all treatment plans prior to treatment.Perform image fusion daily on patients treatment (when applicable), verifying the planned treatment field matches the area of interest for treatment.Perform custom immobilization, through fabrication of patient specific immobilization devices, to accurately align patients for daily radiation therapy.Follow principles of Radiation protection for patient, self, and others.Conduct daily Quality Assurance checks on Radiation delivery equipment.

The Addictions Counselor provides outpatient mental health counseling and substance use treatment to patients within Carle Addiction Recovery Center under the direction of a clinical supervisor.Provide mental health counseling and substance use treatment to patients and their families through individual and/or group settings.Performs mental health/substance use evaluations, including assessing need for ongoing counseling or other services.Provides counseling to patients, using techniques and interventions appropriate to the patient's needs.Works with patient to develop treatment plan, including specific goals and objectives to be addressed in sessionCompletes appropriate documentation in medical record within timeframes established by departmental policy.Identify concerns and make referrals to other treatments as needed.Provides communication back to referring providers about patient diagnosis, treatment plan, and progress as appropriateMaintains patient confidentiality and fulfills provider responsibilities as specified under HIPAA, the Illinois Mental Health and Developmental Disabilities Code, and the Illinois Mental Health and Developmental Disabilities Confidentiality Act.

To provides psychosocial assessment and intervention for clients and caregivers receiving care through Home Health Services. To provides counseling, continuity of care planning, resourcing, and referral services in order to facilitate recovery and maximize benefits from home care.Ensures quality care.* Demonstrates clinical skills through thorough assessments, supportive counseling, provision of a therapeutic environment and by seeking appropriate supervision.* Completes psychosocial assessments.* Provides crisis intervention and supportive counseling on a short-term basis with appropriate referral(s) for ongoing counseling needs.* Plans for continuing care services that should be conducted within a therapeutic context of sensitivity to the emotional factors involved with adjustment to illness and lifestyle changes.* Offers educational and support groups.* Identifies when supervision and/or peer consultation is indicated and seeks out assistance in clinical management of a case, when necessary.* Serves as a client/caregiver advocate by respecting the client's rights, facilitating procedures in accordance with the rules and regulations pertaining to client care.* Provides information and protection regarding the client's rights.Provides quality client interventions.* Maintains a broad knowledge of resources.* Responds to referrals in a timely manner.* Coordinates with other team members* Addresses risk management and legal regulation issues.* Continues to stay updated regarding available community resources* Coordinates the assigned caseload in a complete and timely manner.* Submits appropriate documentation within departmental policy guidelines.* Functions competently and makes sound objective decisions.* Maintains an awareness of risk management issues and involves the appropriate hospital and community agents.Ensures quality care management by providing appropriate documentation, communication and other follow-up by using time, supplies, and other resources productively.* Maintains appropriate communication.* Coordinates with other team members in a timely and pertinent manner.* Demonstrates courtesy and conveys respect in all interactions with other members of the healthcare team.* Responds to phone calls in a helpful and positive manner* Protects client/caregiver's confidentiality'* Provides prompt and pertinent communication and documentation, as necessary, to effective coordinate with other members of the healthcare team and to keep the Home Health Clinical Manager appropriately informed.* Is timely with submission of documentation as well as other interdepartmental communication.Obtains and utilizes educational opportunities for professional development. personal growth and remains up-to-date regarding current trends.* Assumes responsibility for keeping informed regarding developments in healthcare.* Informs and interprets health information to clients/caregivers and other members of the home health team.* Identifies own learning needs by participating in educational activities in the HHSD and MMCI.* Shares information with other staff and client(s)/caregiver(s)* Attends/participates in semi-monthly staff and team meetings* Participates and/or assists departmental work groups.* Is knowledgeable and up-to-date and able to identify payor source requirements including, but not limited to Medicare and Medicaid

$2,500 sign-on bonus and $2,500 relocation (for greater than 50 miles) External Applicants Only Evaluates and treats patients of all ages. Serves as a role model in delivery of professional services and as a clinical resource for staff and students.Collects case history information and integrates information from patients, family, caregivers, teachers, relevant others, and other professionals. Selects and administers appropriate evaluation procedures to meet patient needs. Recognizes the needs, values, preferred mode of communication, and cultural/linguistic background of the patient, family, caregivers and relevant others.Conducts assessment procedures for speech and language pathology. Selects or develops and uses appropriate materials and instrumentation for prevention and intervention.Develops and implements a setting appropriate plan of care with measurable and achievable goals that meet patients need. Collaborates with patients and relevant others in the planning process.Interprets, integrates, and synthesizes all information to develop a treatment plan and make appropriate recommendations for intervention.Evaluates patients with speech and feeding related impairmentsAdministers standardized testing to access level of function compared to age related normsAssess feeding and swallowing impairmentsEducates patients and caregivers on home programs and activitiesCoordinates with pediatric PT/OT on treatment interventionsCompletes daily documentation and charging in therapy EMRCompletes annual requirements as per therapy clinical ladder for senior status which includes supervision of students, completing an approved project, and one in-service training

Evaluates and treats patients of all ages. Serves as a role model in delivery of professional services and as a clinical resource for staff and students.Collects case history information and integrates information from patients, family, caregivers, teachers, relevant others, and other professionals. Selects and administers appropriate evaluation procedures to meet patient needs. Recognizes the needs, values, preferred mode of communication, and cultural/linguistic background of the patient, family, caregivers and relevant others.Conducts assessment procedures for speech and language pathology. Selects or develops and uses appropriate materials and instrumentation for prevention and intervention.Develops and implements a setting appropriate plan of care with measurable and achievable goals that meet patients need. Collaborates with patients and relevant others in the planning process.Interprets, integrates, and synthesizes all information to develop a treatment plan and make appropriate recommendations for intervention.Evaluates and implements intervention plans utilizing activities that designed to improve the functional and emotional needs of the patient/family. Modifies approach in response to patient behavior and performance.Utilizes standardized outcomes measures/testing and instrumental evaluations in a uniform manner to ensure functional performance is accurately reflected.Completes documentation in accordance with regulatory and organizational standards.Collaborates with patient, family and significant others throughout the rehabilitation process and provides education/family training as necessary.Clearly communicates patient performance, change in status, activity/diet recommendations, with the medical team and makes appropriate recommendations for the next level of care.

Evaluates and treats patients of all ages, modifying plan of care as appropriate. Serves as a role model in delivery of professional services and as a clinical resource for staff and students.Demonstrates ability to perform patient transfers with assistance as needed from bed, chair and floor, if applicable. Is aware of and demonstrates safe and appropriate body mechanics to reduce the risk of injury to self, staff and patients.Demonstrates respect by treating our patients and each other with dignity and respect, being empathetic and caring, and staying fully engaged with those who need our services.Designs an appropriate plan of care that integrates goals, treatment, outcomes, and discharge plan. Adjusts the care based on patient response and available evidence.Educates patients, family, caregivers, students, and other health care providers using relevant and effective teaching methods.Evaluates clinical findings to determine physical therapy diagnoses and outcomes of care.Performs examination, selecting reliable and valid examination methods relevant to the chief complaint, results of screening, and history.Produces documentation in accordance with the Clinical Process Policy (CTSCP67).Screens patients using procedures to determine the effectiveness of and need fortherapy services, if appropriate.Uses support personnel according to legal standards and ethical guidelines. Monitors the care delivered by support personnel and provides regular feedback.Evaluates and implements intervention plans utilizing activities that are functional in nature and take into consideration the functional and emotional needs of the patient/family. Modifies approach in response to patient behavior and performance.Utilizes standardized outcomes measures in a uniform manner to ensure functional performance is accurately reflected.Completes documentation in accordance with regulatory and organizational standards.Collaborates with patient, family and significant others throughout the rehabilitation process and provides education/family training as necessary.Provides supervision to PTA and rehabilitation technicians in accordance with regulatory agencies.Clearly communicates patient performance, change in status, activity/transfer recommendations, and recommendations for discharge disposition and equipment required for the next level of care with the medical team.

The Social Worker for Community Health Initiatives provides professional services to clients and their families eligible for the Healthy Beginnings Services in order to meet identified psychosocial, emotional, financial and environmental needs. This SW will also serve patients/families on board the Mobile Health Clinic performing Social Determinants of Health and providing appropriate referrals/resources. The social worker provides psychosocial assessments, supportive counseling, emergent crisis intervention appropriate to setting, financial resource information, environment enhancements, advance directive planning and referrals to community agencies for clients and their caregivers/families in the client's home, mobile health clinic (MHC), or other settings. Using an interdisciplinary team approach, the social worker ensures clear communication and helps to facilitate care transitions. The social worker identifies and implements interventions at the individual and systemic levels and provides expertise to high risk clients across the continuum. The social worker works collaboratively with the multi-disciplinary team to support the RN performing at the highest level of their license in addition to maximizing the social worker's specialized training to address complex cases. Social Services are provided as part of a collaboration with interdisciplinary teams in adherence to the NFP model, and to policies, procedures, guidelines, and standards of NFP and of the Carle Health System.Involves client/patient/family in case planning decisions.Provides social work intervention to clients and their families eligible for the Healthy Beginnings and/or Mobile Health Clinic services.Helps to facilitate care transitions, referrals to scoial services, and other specialits when needed.Keeps the director/manager informed of problematic cases, especially those involving legal or risk management issues.Provides assistance and advocacy to clients in obtaining financial resources and government entitlements.Develops and maintains tracking system of social services referrals /outcomes.Provides information and counseling for advance directives and health care power of attorney.Provides social work intervention to patient/families eligible for the NFP Program.Responds to referrals from healthcare team members to identify available services for case specific needs.Collaborates with nurse home visitors / supervisors / mobile health clinic staff to meet the needs of high risk populations.Details (direct or incidental) possible to enhance service/care is communicated across service lines and among disciplines.Documents all client interactions, significant observations, interventions, and actions taken in the client's medical record in an appropriate and timely manner.Formulates, develops, and implements a plan utilizing appropriate social work interventions. Provides education and counseling to clients and families around issues related to adaptation to the client's illness and/or life situation. May utilize crisis intervention, brief and long-term individual, group, and family therapies.Assists clients and their families in establishing goals and outcomes through therapeutic relationships by providing education, support, and referral resources.Assesses physical, emotional, social, spiritual, and environmental needs of clients and their families as they relate to the NFP domains.As requested/required, participates in community coalitions and other community organizations in support of NFP as well as promotes public awareness of Healthy Beginnings Services and the Mobile Health Clinic.Facilitates education/training modules to assist RN staff managing basic social work needs.