Inpatient Social Worker (40 hr, 9:00am-5:30pm, Every third weekend & holiday required)
Company: Beth Israel Deaconess Hospital Needham
Posted on: November 18, 2023
When you join the growing BILH team, you're not just taking a
job, you're making a difference in people's lives.
Day (United States of America)As a core member of the
interdisciplinary care team, the social worker effectively
collaborates to actively address the coordination of post-acute
care services and the provision of psychosocial support services to
patients and families. Serves as a resource for the health care
team on appropriate and effective disposition that reduces the
length of stay and readmission.Job Description:
Assessment and Planning:
As a member of the interdisciplinary care team, identifies
high-risk psychosocial factors of patients/families that impact
status and discharge planning.
Educates the care team on the impact of social drivers of health
(SDOH) on medical treatment and care planning.
Develops a psychosocial assessment, and intervention plan regarding
identified patient and family needs utilizing all available sources
Participates in inter-disciplinary and inter-agency collaborative
efforts to identify and coordinate care, treatment and post-acute
Psychosocial assessment includes social, economic, cultural,
age-related, and behavioral factors.
Demonstrates competency in knowledge of community resources to
address identified needs.
Provides crisis intervention and counseling services to assist
patients and families with their emotional needs and adjustment to
the medical episode.
Documents assessments, intervention plans, and outcomes that are
consistent with departmental guidelines and Hospital policies.
Provides accurate, timely, and appropriate documentation of all
social work assessments and interventions in the electronic medical
record per regulatory policies and procedures (this says the same
thing as the bullet above. We can eliminate the bullet above.)
Assesses and screens patients for interpersonal violence (child,
adult, elder). Provides education and facilitates reporting by
interdisciplinary team members per hospital policies.
Provides education and facilitates reporting by interdisciplinary
team members with direct knowledge of patient condition and events
Screen and identify SDOH risk factors that contribute to
readmission, such as inability to access medications, lack of
transportation, insurance status, etc.
Care Coordination/Care Transitions
As a member of the Care Transitions, the inpatient social worker
collaborates with care providers and third-party payors to ensure
that all appropriate services and resources are utilized in a
timely and efficient manner.
Actively participates in multidisciplinary rounds (MDRs) and care
conferences on assigned units and assists with documenting all
pertinent information in the medical record.
Establish her/himself as an integral part of the team and present
each day in the units to which they are assigned.
Maintains timely communications with third-party payor
representatives to identify discharge needs and available
Seeks out members of the treating team to identify the most
efficient/effective plan to progress care and offers to assist with
the identification of resources to facilitate the plan of care.
Provides patient/support system education and resources regarding
options for care and completes relevant referrals to health
agencies, mental health facilities, counseling services, social
agencies, post-acute care providers, and disease or
condition-specific resources in an effective and timely manner
based on the patient condition/needs to minimize delays in patient
receipt of services.
Demonstrates expertise in facilitating end-of-life discussions and
issues, including goals of care, hospice, and palliative care.
Demonstrates expertise in addressing advance directives, power of
attorney, health care representative, and guardianship issues and
serves as a resource to the interdisciplinary health care team
consulting with Legal as needed.
Maintains working knowledge of in-house and community resources and
awareness of legal/risk issues related to care planning.
Identify and utilize appropriate interventions to address barriers
to care/discharge; locate resources; identify options and available
supports; facilitate referrals and applications to
government/community agencies; advocate for access to resources;
coordinate referrals and/or placement plans; assist patient and
family to emotionally prepare for transitions; prevent readmissions
for non-medical reasons. Particular attention to high-risk, complex
May facilitate support and psycho-educational groups.
Facilitates communication with the patient/family. This covers both
the clinical aspect of communication and the coordination of
Document evaluations and ongoing work in a timely and comprehensive
fashion that meet departmental standards.
Utilize appropriate documentation templates for assessments, brief
interventions and progress notes in EHR.
Initiate evaluation within 24-48 hours or one business day of the
referral or consistent with departmental standards to respond the
same day when possible.
Complete all appropriate forms within established time frames.
Complete departmental statistics within established timeframes.
Ensure care coordination needs of assigned patients are met, and
there is adequate documentation in the patient's medical
Maintain patient confidentiality and complies with professional
ethics according to professional (NASW) and department
Master of Social Work degree from an accredited school of social
State of Massachusetts licensure as an LCSW or LICSW
Two years of healthcare social work/case management experience
CCM or ACM (Commission for Case Management or American Case
ExemptAs a health care organization, we have a responsibility to do
everything in our power to care for and protect our patients, our
colleagues and our communities. Beth Israel Lahey Health requires
that all staff be vaccinated against influenza (flu) and COVID-19
as a condition of employment. Learn more about this
More than 35,000 people working together. Nurses, doctors,
technicians, therapists, researchers, teachers and more, making a
difference in patients' lives. Your skill and compassion can make
us even stronger.
Equal Opportunity Employer/Veterans/Disabled
Keywords: Beth Israel Deaconess Hospital Needham, Boston , Inpatient Social Worker (40 hr, 9:00am-5:30pm, Every third weekend & holiday required), Human Resources , Needham, Massachusetts
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