General Summary

Under direct oversight, conducts interviews with patients to learn of their medical, psychological, and social histories in an effort to identify problems and assess need for referrals and resources. Works as a member of the interdisciplinary treatment team to identify, address, and resolve barriers and stressors that contribute to the patient's presenting problem and may interfere with obtaining maximum benefit from healthcare services.

Principal Responsibilities and Tasks

The following statements describe the general work performed in this role. It is not an exhaustive list of all duties that may be performed:

1. Obtains information to identify the need for the provision of social work services. Identifies barriers to health care including social and medical needs.
2. Participates in designing services with an interdisciplinary team to meet the needs of patients and/or their families with the total health care system. Coordinates care for patient's treatment/discharge.
3. Provides psychosocial interventions using basic knowledge of social work practice models such as problem-solving, crisis intervention, task-centered, and solution focused care to address identified needs and develop safe care plans.
4. Monitors patients' progress & identifies patients who are at-risk.
5. Provides general preliminary social work services/coordination of care to patients who are or are threatened with situations detrimental to their wellbeing, in accordance with generally accepted social work practices and departmental protocols. Consults with Clinical Social Worker/supervisor for complex or at-risk cases.
6. Provides immediate and after care referrals to improve patient stability. Confirms linkage to care as needed/required.
7. Assists patients and/or families with problem-solving and decision-making around personal, health, social, educational, vocational, financial and other interpersonal concerns within the context of their care/treatment area.
8. Seeks consultation, as needed, with expert colleagues and other disciplines on the care team for guidance with assessment, planning, and intervention, and overall plan of care.
9. Provides support and interpretation to patient and/or families of their problems and goals.
10. Attends team/interdisciplinary meetings to provide advocacy focused on the client. Encourages patient to be an active participant in their care.
11. Assists the care team with ensuring patients are efficiently and effectively moved throughout the healthcare system.
12. Documents all work in a timely manner pertaining to the care setting or required by regulatory standards. Only discloses information necessarily with an ROI. Notifies patients of their informed consent for treatment, as applicable.
13. Completes all specific job tasks within their assigned department as outlined by supervisor.

Provides Care Coordination and discharge planning services for all inpatients accessing care through the Univ. of Md. Upper Chesapeake Health. Position is needed to cover weekends, some holidays, and/or weekdays if candidate is available. May interact with clients or customers ranging in age from newborn to geriatric.