Position Summary

General Summary/Responsibilities:

The Social Worker will be an integral member of the AIM multidisciplinary team. Together with nurses and community health coaches, the Social Worker will assist in care plan implementation, provide short-term counseling to patients, help develop care management strategy for enrolled patients and help create linkages for the various health and social needs of patients. The team works in the field in a variety of settings, including patient homes, medical centers, and the ED/inpatient floors of each Premier Health hospital.

DIMENSIONS

Interventions per program and physician's plan of care.

Scope/Span of Control: N/A

Supervisory Responsibilities (if applicable)

Supervises FTEs: No

Number of FTEs Supervised: 0

Exercises full management authority including performance reviews, discipline, termination and personnel hiring No

Fiscal Responsibilities (if applicable)

Annual Revenue in Dollars: N/A

Annual Expense in Dollars: N/A

Financial Accountability: N/A

Population Served

Age of Population Served - Choose all that apply

? Infant (birth - less than 1 year)

? Pediatric/Adolescent (1 - less than 18 years)

? Adult (18 - 64 years)

? Geriatric (65 years & older)

? All Age Groups (Birth & Above)

? Not Applicable

Organizational Standards

Work in conjunction with nurse navigator on intake assessment including social needs/barrier identification of patients referred and enrolled in the program; determine plan for care with nurse navigator; responsible for management and completion of social/behavioral tasks for each individual patient

o Tasks may include, but are not limited to:

Education geared toward self-reliance and independence

Interventions aimed at reducing barriers to medical care

Coordinate behavioral health services

Assist pt in making appointments as necessary and accompany patients to appointments as needed

Referrals to community resource services

• Engage patients across care settings such as the transition from hospital to home
• Assist patients and their families with personal and environmental difficulties which predispose them toward illness or interfere with achieving maximum level of functioning and self-sufficiency
• Act as a liaison between hospitals, primary care providers, specialists, community resources and managed care/insurance plans on behalf of enrolled patients to ensure patient-centered coordination of care
• Serves as a patient advocate and assists in the identification and improvement of service delivery.
• Provide crisis intervention as needed
• Provide direct supervision to the community health coach
• Develop and maintain partnerships with local service organizations and community resources to broaden support services for patients
• Provide Notary Public services to patient/family members in order to complete Advance Directives.
• Enter and maintain electronic records, compile reports and complete other program documentation in a timely manner , other administrative responsibilities as needed
• Participate in interdisciplinary case conferences, staff meetings and team meetings
• Play a consistent and active role in program development and growth
• Meet on a regular basis with clinical supervisor to review case workload.

Essential Duties & Functions

Essential Duties & Functions:

Must have available phone to communicate and transportation, with appropriate licensure and insurance, to visit homes and other sites. Interacts with physicians, nurses, social workers and other disciplines, administrative personnel, and community resources.

Other Duties & Functions:

As assigned

Education

Minimum Level of Education Required: Master's degree

Additional requirements

Type of degree: Master's degree is preferred

Area of study or major: MSW

Preferred educational qualifications: N/A

Position specific testing requirement: N/A

Licensure/Certification/Registration

Current Licensure (LSW, LISW preferred) in the State of Ohio

Experience

Minimum Level of Experience Required: 3 - 5 years of job related experience

Prior job title or occupational experience: 3-5 years of experience providing clinical services; experience in home care or community/outpatient setting preferred.

Prior specific functional responsibilities: N/A

Preferred experience: N/A

Other experience requirements: N/A

Knowledge/Skills

Ability to effectively provide clinical care to socially and medically complex patients in a variety of non-traditional settings

Ability to work collaboratively in a team and manage multiple priorities, utilize effective time management skills, and exercise sound administrative and clinical judgment

Demonstrated ability to work well with people of various ages, backgrounds, ethnicities, and life experiences

Exceptional organizational and interpersonal skills, with attention to detail required; strong oral/written communication skills is a must

Computer skills necessary

Must be capable of standing, stooping, bending and lifting up to 50 lbs.

Other duties and responsibilities as directed.

Physical Requirements & Working Conditions

Physical Requirements

Pulling

2 - Occasionally (11% - 40%)

Standing

3 - Frequently (41% - 75%)

Other sounds

3 - Frequently (41% - 75%)

Twisting

2 - Occasionally (11% - 40%)

Reaching

2 - Occasionally (11% - 40%)

Visual Acuity Near

3 - Frequently (41% - 75%)

Walking

3 - Frequently (41% - 75%)

Manual Dexterity

2 - Occasionally (11% - 40%)

Visual Acuity Far

3 - Frequently (41% - 75%)

Sitting

2 - Occasionally (11% - 40%)

Use both hands

3 - Frequently (41% - 75%)

Vision Color

2 - Occasionally (11% - 40%)

Pushing

2 - Occasionally (11% - 40%)

Talking

3 - Frequently (41% - 75%)

Concentrating

3 - Frequently (41% - 75%)

Climbing

1 - Rarely (0% - 10%)

Lifting <10 pounds

3 - Frequently (41% - 75%)

Interpersonal Skills

4 - Consistently (76% - 100%)

Stooping

2 - Occasionally (11% - 40%)

Lifting >10 pounds

2 - Occasionally (11% - 40%)

Reading

4 - Consistently (76% - 100%)

Kneeling

1 - Rarely (0% - 10%)

Normal hearing both ears

3 - Frequently (41% - 75%)

Thinking

4 - Consistently (76% - 100%)

Working Conditions

1. General office environment.

2. Climate controlled environment.

3. May work some evenings and weekend hours to complete projects or meet the needs of the department.

4. May be required to work overtime as defined by the needs of the department.