* Assists the patient, significant others, physician, and health care team staff to understand significant personal, emotional,
environmental, and social factors and difficulties related to the patient's health problems; which interfere with maximizing the
benefit of medical services and the plan of care.
* Contributes as a health care team member to the development of comprehensive, integrated treatment plans for patients.
* Instructs health care team members on community resources available to assist patients.
* Plans for continuity of care with hospitals and community agencies.
* Assesses and treats social and emotional factors related to patient's illness to determine ability to cope with daily living
* Assists the patient and significant others to understand, accept, follow, and implement medical recommendations.
* Assists the patient and significant others in utilizing community resources which will help the patient to achieve and maintain
* Identifies gaps in community resources and stimulates resource development and/or improvement.
* Visits patient according to Plan of Treatment; completes a progress note for each visit; and submits progress notes to the
agency on an at least weekly basis.
* Participates in staff conferences and committees as necessary.
* Fulfills necessary mandatory education on annual basis
* Provides in-service to agency staff as needed
* Sends the physician a written summary report on patient's condition at least every 60 days
* All other duties as assigned
* Master's Degree from a school of Social Work accredited by the Council of Social Work Education.
* One year of social work experience in a healthcare setting.
* Current CPR certification.
* Current driver's license, vehicle insurance, and access to a dependable vehicle or public transportation.
* AL, AR, CA, CO, GA, ID, IL, KY, LA, MA, MD, MI, MS, NC, NH, NJ, NM, NV, OH, OR, SC, TN, TX, WI, WV: Licensed as a Social
Worker from the StateBoard of Social Work.