Conduct Social Work assessments to determine the psychosocial needs preferences and goals of the participants and actively participate in team meetings to develop participant care plans
Deliver and document social work interventions as agreed upon in the participants care plans including but not limited to arranging necessary resources and services assisting with care transitions providing individual as well as group counseling and case management
Work with the primary care physician and other members of the care team to guide smooth care transitions between settings (e.g. hospitals skilled nursing facilities homes etc.)
Initiate coordinate and facilitate care conference meetings to ensure the highest level of care coordination among other care team members participants and other people within the participants support network (family informal caregivers etc.)
Provide discharge planning when participants disenroll from the program
Job Requirements:
Masters Degree in Social Work (MSW) required
Minimum of one (1) year of experience with a frail or elderly population
Previous experience coordinating and facilitating care conference meetings
Previous experience assisting people with behavioral health & substance abuse issues preferred
Benefits:
Medical insurance coverage (Medical Dental Vision)
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