The Medical Social Worker provides direct casework and counseling services to the patient/family unit. The social worker obtains evaluation of the psychosocial problems and defines social service goals for alleviating problems. The social worker is skilled to in communication regarding end of life conversations and can discuss goals of care with the patient/family.

Essential Job Functions/Responsibilities

1. Performs the psychosocial assessment of patients, families/caregivers in a timely manner and identifies the needs of the patient and family/caregivers.
2. Educates and completes advance directive documents with the patients/families on service.
3. Counsels patient and family/caregivers with end of life concerns and discusses appropriate coping skills.
4. Provides assistance and follow up with applications for Medicaid, Provider Services and other community based services.
5. Requests spiritual support for patient and families as needed.
6. Attends interdisciplinary team meetings. Communicates and collaborates with the interdisciplinary group to create, review and revise the patient's plan of care.
7. Assists team members in understanding significant social and emotional factors related to health problems and death/dying issues.
8. Communicates with hospitals, doctors, home health agencies, State Adult Protective Services, and other providers as needed.
9. Develops and maintains a close working relationship with providers in the community and serves as a liaison between patient/family and the providers.
10. Actively maintains a working knowledge of the Medicare and Medicaid rules and regulations for hospice and can communicate the benefit to patients/families.
11.  Completes, maintains and submits accurate and relevant clinical notes, physical examination notes, assessment visit notes, collaboration notes and other documentation in the medical record