Responsible for completing psychosocial assessment of patients, for post hospital discharge needs including home care, nursing home placement, financial assistance, counseling, and other community resources. Develops and implements linkage on the health care continuum for complex and high-risk patients. Assists patients and families with short-term counseling and planning following medical crisis.

We are currently seeking LICSW, MSW, LSW professionals for this role.

• Conducts patient psychosocial status assessment and communicates to health care team as needed to enhance quality and care
• Assists patient/family in utilizing appropriate community resources
• Develops relationships with key community programs, referral resources and community members
• Acts as a resource for legal issues regarding 72 hour holds, guardianships, petitions for commitment
• Acts as a consultant, patient advocate and liaison for patients and families in areas of social work indicators and complex psychosocial issues
• Schedules and facilitates family conferences regarding care planning
• Provides supportive counseling to assist patients/families in adjusting to disability and illness, and for realistic planning for post hospital care
• Consults with referring provider and other team members to ensure quality care as part of a comprehensive treatment plan of care within HealthEast Home care
• Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards
• Actively participates in creating and implementing improvements
• Performs other responsibilities as needed/assigned

Required:

• Master's degree in Social Work from an accredited school of social work
• Either Licensed Graduate Social Worker (LGSW) or Licensed Independent Clinical Social Worker (LICSW) through MN Board of Social Work
• 1 year of hospital social work experience, 2 years of nursing home experience, or equivalent direct clinical experience required
• Knowledge of applicable laws and regulations. Knowledge of community resources