Hospital Social Worker (LSW/LGSW)

Job Description

POSITION SUMMARY STATEMENT:

The MSW Social Worker provides patient-centered care management services to patients and families in an inpatient hospital setting. This position serves as an integral member of the interdisciplinary healthcare team and is responsible for identifying care coordination needs in collaboration with the inpatient and ambulatory care teams, along with the patient and the patient's external support systems. Within the context of an interdisciplinary team, the MSW Social Worker participates in progressing patients toward discharge/next level of care by identifying barriers, implementing appropriate interventions, and securing transition plans that are aligned with shared goals of care. The MSW Social Worker will consistently and thoughtfully apply social work values and continuous quality improvement in daily work.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  • Master's of Social Worker (MSW)
  • Minimum of 1 year experience in a medical or mental health setting practicing social work
• Licensure/ Registration/ Certification:
  • Current Minnesota license of Licensed Graduate Social Worker (LGSW)
• Knowledge, Skills, and Abilities:
  • Knowledge of the values, principles, and methodologies of social work
  • Exceptional organizational and time management skills

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  • Prefer 2+ years of experience as a social worker with hospital experience

ESSENTIAL DUTIES:

1. (60%) -Care Coordination and Clinical Social Work Practice
   1. Conducts comprehensive psychosocial assessments utilizing a patient centered, strengths based, and trauma informed approach to identify psychosocial needs, barriers to care, safety concerns, and discharge planning needs.
   2. Assesses social determinants of health, support systems, mental health needs, coping strategies, substance use concerns, housing stability, financial challenges, and other factors impacting health outcomes.
   3. Obtains and integrates information from patients, families, caregivers, community providers, and interdisciplinary team members to support assessment and care planning.
   4. Collaborates with patients, families, and the interdisciplinary team to develop and implement individualized care transition plans that promote safety, continuity of care, and optimal health outcomes.
   5. Facilitates referrals and connections to community resources, post-acute services, mental health services, and other supportive services as appropriate.
   6. Provides crisis intervention, emotional support, brief counseling, and supportive interventions related to adjustment to illness, hospitalization, grief and loss, trauma, mental health concerns and life stressors.
   7. Participates actively in interdisciplinary rounds, care conferences, and team meetings to advocate for patient needs and facilitate coordinated care planning.
   8. Assists patients and families with advance care planning, health care directives, guardianship considerations, and identification of surrogate decision-makers when appropriate.
   9. Demonstrates knowledge of community resources, healthcare funding sources, and applicable local, state, and federal regulations impacting patient care and discharge planning.
   10. Communicates effectively and professionally with patients, families, healthcare team members, and community partners to support coordinated, patient-centered care.
   11. Identifies and escalates complex psychosocial, mental health, or system barriers that may impact patient progression, discharge readiness, or access to services.
   12. Documents assessments, interventions, care plans, referrals, and patient outcomes accurately and timely within the electronic medical record.
   13. Maintains patient confidentiality and adheres to organizational, legal, and ethical standards of social work practice.
   14. Utilizes clinical judgement, available data, and organizational tools to support safe care transitions and identify patients at increased risk for adverse outcomes or readmission.

   15. Provide mental health crisis assessment, crisis intervention, suicide risk support, and coordination of mental health services in collaboration with care team.

2. (15%) Patient, Family, and Team Education
   1. Provides education, guidance, and support to patients/families/caregivers regarding psychosocial concerns, coping strategies, available resources, and post hospital care needs.
   2. Serves as a psychosocial resource to the interdisciplinary team through consultation, collaboration, and informal education.
   3. Participates in educational activities, presentations, or departmental initiatives, to enhance staff knowledge and patient care practices.
   4. Educations patients, families, and health care team members on topics such as social drivers of health, mental health and substance use, community resources and support services, healthcare funding, guardianship, advance care planning, trauma informed care, grief, loss and adjustment to illness.
3. (15%) Collaboration and Professional Relationships
   1. Develops and maintains collaborative working relationships with patients, families, interdisciplinary team members, community agencies, and external partners.
   2. Functions as an integral member of the interdisciplinary care team, contributing social work expertise to support patient centered care and effective care transitions.
   3. Participates actively in department meetings, team discussions, quality initiatives, and organizational activities.
   4. Contributes to a positive, inclusive, and respectful work environment through teamwork, professionalism, and shared accountability.
   5. Supports departmental and organizational goals through engagement in process improvement and problem-solving efforts.
4. (10%) Professional Development
   1. Maintains current knowledge of social work practice standards, healthcare regulations, mental health trends, and evidence based care coordination practices.
   2. Demonstrates accountability for professional growth through ongoing education, licensure maintenance, clinical supervision, and incorporation of feedback into practice.
   3. Participates in quality improvement initiatives, committees, and special projects as assigned.
   4. Perform other duties as assigned.

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.

ORGANIZATIONAL EXPECTATIONS:

Values

All colleagues are expected to live our values:

Excellence:We strive for the best results and always look for ways to improve.

Compassion:We care and show empathy and respect for each person.

Partnership:We are strongest when we work together and with those we serve.

Integrity:We are open and honest, and we keep our commitments.

Additional Expectations:

• Complies with safety instructions, observe safe work practices, provides input on safety issues, and promotes a safe work environment.
• Maintains regular and timely attendance.
• Protects confidentiality.
• Demonstrates participation in and support of the organization's Corporate Integrity Program by participating in compliance-related education and training and complying with the organization's policies and procedures.
• Timely completion of all mandatory education and organizational requirements (i.e., licensure/certification, Employee Health and Wellness requirements, annual training, etc.)

POPULATION SPECIFIC COMPETENCIES:

Departments will need to determine the appropriate competencies in their areas for their specific patient populations documented in the essential duties section.

Examples of items that can be included are:

• Identifies expected outcomes for a plan individualized to the patient or situation specific to the needs of the population served.
• Communicates effectively with patients, families, and team members.
• Integrates practices that supports patient safety, acknowledges variations in populations served.
• Anticipates the needs of the population served as well as the unique characteristics of the communities served.
• Anticipates the needs of the population in providing culturally responsive care and develops an individualized plan for patients and families.

LEADERSHIP RESPONSIBILITY:

No supervisory responsibility of staff, may supervise social work interns.

Critical Job Demands

Section 1:Place an "X' next to ONE of the terms that best describes the frequency for each of the Critical Demands.

Section 2:Place an "X" next to ONE of the terms that best describes the Strength Rating for this job classification which is expressed by one of five terms: Sedentary, Light, Medium, Heavy, and Very Heavy.

Note: During any patient handling task, if any caregiver is required to lift more than 35 lbs. of a patient's weight, assistive transfer devices should be used for the transfer.