Provides therapeutic intervention and social work services to patients and their families to enhance comprehensive integrated and uninterrupted care in the hospital and to have continuity of care in the community Department is looking for weekday per diem with minimum requirement of 2 days per week weekend and holiday rotation Include but are not limited to Assesses the patients psychosocial situation in relation to the medical and needs and plans appropriate interventions and treatment goals to improve patientfamily functioning Interviews patients family members andor significant others identified through case finding or referrals to assess needs for social work andor interventions related to social determinants of health Participate and Provide input in Multidisciplinary Rounds PsychoSocial Context Function as resource and advocate on behalf of the patient and family for discussions involving Advanced Care Planning Other duties as assigned Provides psychosocial support to patients and families during adjustment to illness and life changes A Provides preventive protective or supportive services to patients who are in or threatened by situations detrimental to their wellbeing B Collaborates with the health care team regarding inhospital needs and posthospital care C Maintains current with availablepsychosocial services programsservices and provides relevant information to patients families staff and community organizations D Develops and maintains collegial relationship with community organizations Coordinates and maintains a viable psychosocial discharge planning program for the assigned service area to identify patient needs and plan for appropriate aftercare services Ensures continuity of care through comprehensive and appropriate discharge planning with patient family andor significant others Long Term Custodial Care Acute rehab Subacute rehabSkilled Nursing Facility SNF LTAC Dialysis Hospice Homelessness solutions and resources Documents appropriate data from psychosocial assessments individual contacts family interventions and discharge planning according to department policy and procedures and State Federal and Joint Commission stipulated requirements Develops a social service network with city state or other governmental services that serve the needs of the assigned patient population to assist patients in obtaining such services as food stamps and other financial supports and assistance in obtaining transitional housing Evaluates psychosocial services program objectives and results and participates in program planning and improvement in accordance with the mission of the hospital and department Maintains confidentiality in accordance with hospital and departmental policy and professional standards May accompany patients to obtain benefits entitlement or other services
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