Clinical Social Worker, LCSW
Newton-Wellesley Hospital(NWH)

Under the direction of the Care Coordination Social Work Supervisor and with support from Department leadership, the Care Coordination Social Worker (CCSW):

• Assists patients and their families or significant others with the stress and difficulties related to illness, personal issues, financial difficulties, and other emotional/mental health issues. The social worker's interventions take into consideration the patient's strengths, resources, insurance coverage, family system, and motivation for change.

• Collaborates with nurse care managers and other members of the multidisciplinary team to facilitate safe and effective discharge plans.

• Supports the mission of the Hospital and participates in the Hospitals' Performance Improvement activities.

The CCSW provides services to patients admitted to the following areas within Newton Wellesley Hospital: inpatient medical/surgical units, inpatient Pediatrics, Labor and Delivery, Post Partum care units and nurseries, Special Care Nursery, Critical Care units, and the Emergency Department.

Essential Functions:

Supportive Case Work

In conjunction with a nurse case manager and other healthcare team members, provides support to patients and families in crisis or adjusting to life changes with the ultimate goal of helping to facilitate the development of a safe, optimal and appropriatedischarge plan.

Utilizes crisis intervention, short-term, family systems and group work skills.

Discharge Planning

• Identifies patients who may require post discharge services utilizing high-risk screening criteria, referrals and/or other methods of communication and collaboration.

• In collaboration and/or consultation with the patient, the family, the attending and/or primary care physician, nursing staff, other appropriate clinical staff, third party payors and/or community based care coordinators or other appropriate outside agencies; develops and oversees safe, effective, and efficient discharge plans.

• Provides ongoing oversight of the patient's status in collaboration with a nurse case manager to determine the appropriate post acute level of care and makes changes to the discharge plan as needed.

• Ensures the implementation of the discharge plan including facility/agency referrals and availability of services.

• Documents all patient/family contacts including any financial and/or legal considerations discussed in the medical record according to Hospital policy.

• Completes all medical record documentation as per departmental/Hospital policy including necessary discharge paperwork in a timely and thorough manner.

• Ensures that accurate and complete discharge paperwork is sent to post acute service providers according to Hospital policies and procedures.

• In collaboration with external healthcare providers and primary care physicians; participates in the follow-up of patients following a hospital episode of care.

• Provides expert consultation to the multi disciplinary health care team about aspects of emotional, social and financial care issues.

• Maintains comprehensive knowledge of community resources.

• Coordinates all adoptions on the maternity unit (MCH/SCN specialty area).

• Coordinates the guardianship process for inpatients needing guardianship for discharge from the acute care facility.

• Offers information and referrals to patients and families.

• Participates in the department's educational programs, staff meetings and other work related groups.

• Supervises social work students and interns if requested by manager/director.

• Consults and advocates during psychosocial emergencies in collaboration with the provider team.

Financial and legal

• Ensures third party payor approval for psychiatric inpatient placement.

• Assumes responsibility for identifying and /or preventing inappropriate resource utilization

• Understands patient's insurance coverage benefits and plans for discharge accordingly.

• Refers patients and families to appropriate resources or community agencies to apply for Mass Health, Medicare, Disability, etc.

• Consults with other members of the medical team on issues related to abuse, neglect, abandonment, guardianship, etc. and complete appropriate reports or documentation as required by law or Hospital policies.

• Facilitates the guardianship process for hospitalized patient as needed.

• Identifies external programs to assist patient with obtaining prescriptions, medical supplies and equipment, provide utilities i.e. heat and electricity if unable to afford, and to secure a primary care provider.

• Provides expert knowledge, guidance and support to the medical and nursing staff and other members of the hospital team regarding psychosocial issues including abuse and neglect situations, need for guardianship, substance abuse, homelessness, psychiatric placements, need for community resources, and financial or insurance needs.

• Completes mandated reports as appropriate for the role of "mandated reporter."

Quality /Safety/Performance Improvement

• Identifies documents and reports quality of care issues in accordance with Hospital and departmental policies and procedures, including but not limited to occurrence screening, patient incidents and risk management issues.

• Contributes to the Department and Hospital's mission by serving on committees and participates in pertinent community activities.

• Participates in the Department and Hospital quality improvement initiatives.

• Provides patient care and services that are based on safe and approved standards of care.

• Carry out other functions as deemed necessary for Hospital compliance with State and Federal regulations and JCAHO accreditation.

Other Duties

• Participates in special projects such as audits, policy and program development, and other such duties as directed.

• Participates and/or carries out other duties as assigned or requested.

Qualifications
Education/Licensures/Certifications

• Master's degree from a graduate program accredited by the Council on Social Work

Education.

Graduate and post graduate education must include adult normal growth and behavior theory and adult psychopathology

• Licensed in MA at the Licensed Independent Social Work level or licensed clinical Social Work level.

Experience

• Post Master's experience (2-3 years) preferred.

• Acute care setting experience preferred

• Knowledge of the special needs and behaviors of infant, child, adolescent, adult, older adult patients preferred.

Skills and Abilities

• Assessment and planning skills.

• Demonstrated ability to communicate effectively verbally and in writing.

• Developed organizational skills to work in a fast-paced environment.