Social Worker MSW-Ortho PMUC

Penn Medicine University City is looking for a Social Worker to work Full-Time with the Ortho PMUC team @ 3737 Market St.!!!!!!

Summary: The social worker will provide and document individualized social work assessment, care planning, intervention and outcome evaluation, and resource support for patients. The Social Worker will be a member of a care team that spans multiple sites and will possess strong coordination and communication skills to provide seamless care for patients in the program.

 Assessment: 

Collaborates with other members of the health care team to identify patients with complicated psychosocial issues/needs

 • Collects initial data systematically from patients, patient charts, and clinician referrals and from other available sources.

 • Assesses the needs of patients/families within the limitations of the patient’s support systems and social functioning and in relationship to the patients illness, treatment and care needs • Obtains and documents patients/families psychosocial issues/needs accurately, concisely and in a timely manner.

 • Correctly identifies and prioritizes urgent patients/families psychosocial issues/needs that require immediate attention.

 • Correctly identifies patients/families needs/issues that may impact continuity of care or affect timely discharge from the hospital.

 • Communicates assessment data to appropriate health care team members/resources.

 • Collaborates with clinical team at regular meetings to identify difficult cases and develop management plan • Planning: Establishes a plan of care to address identified patients/families psychosocial issues/needs in collaboration with the patient/family, and the health care team.

 • Creates a plan of care that addresses the identified needs/issues of the patient/family.

 • Documents and communicates the goals to be achieved, the expected behaviors of the patients/families and any linkages/referrals to community/government agencies/programs. 

• Modifies/updates plan to reflect changes in patients/families situations. • Develops an organized process/log for tracking patients/families consults and referrals.

 • Works with providers to complete, and referrals to patients/families and acts as a liaison between referring agencies/programs and the health care delivery team.

 • Assists patients/families to secure financial assistance to assure accessibility of ongoing health care services, including medication

 • Maintains up to date knowledge of third payer requirements and the criteria for service referrals.

 • Counsels and educates patients/families to understand the benefits of and accept referrals to specialized health care staff and services.

 • Provides instruction to patients/families to promote and improve quality of care

 • Maintains a working knowledge of the resources available in the community for patients and their families and maintains cooperative relationships with them. • Provides information, paperwork and referral to community and government resources, agencies and programs for ongoing assistance with psychosocial concerns of both patients and families.

 • Implementation: Provides consultation, counseling, instruction

 • Provides counseling and linkages to services for patients and their families including but not exclusively limited to protective services, foster care, adoption, SCAN, substance abuse, mental health, physical, sexual, emotional and coercive abuse, bereavement counseling, parenting skills and difficulty coping with medical diagnoses or chronic conditions. Accountabilities

 • Communicates, coordinates and insures the exchange of both written and verbal communication regarding patients/families issues/needs between referring agencies and the health care delivery team.

 • Maintains a patient log of consults/referrals that is current and accurate. • Appropriately documents all case management interventions and maintains complete and accurate records of patient care.

 • Completes accurate billing encounters for services provided and assures that encounters are submitted within department timeframes.

 • Participates in CEQI endeavors, research projects, JCAHO endeavors and meetings within the department and assigned areas.

 • Participates in community activities designed to improve community resources needed for patients/families

 • Provides information and education to patients about disease and connects patients to services to support goals of care.

 • Interviews and collaborates with patient/family to assess aftercare options providing guidance information and support in decision making

 • Coordinates all aspects of the discharge process for patients with complex post-acute needs returning home

 • Works with patients and their families to help them understand the impact their illness may have on their lifestyle, family, relationships and home situation • Actively manage patients to decrease Emergency Department admissions and visits.

 • Evaluation: Evaluates the appropriateness and effectiveness of interventions and referrals and communicates results or modifications to the health care delivery team.

 • Evaluates interventions and referrals through an ongoing assessment process when interacting with patients/families or referral agencies in person, via telephone or written correspondence.

 • Documents outcome assessments in medical records (for clinical encounters, EPIC) and required reporting logs.

 • Modifies interventions based on patients/families situations and outcomes.

 • Communicates interventional outcomes/modifications to the health care delivery team and prepares data collection forms and reports as required.

 • Collaborates in CEQI initiatives by identifying patterns of over and under utilization of services and delays in services and makes recommendations to improve access or service quality. 

• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures • Other duties as assigned to support the unit, department, entity, and health system organization  

Education/Experience Req.:   

Master's Degree Social Work And 1+ years Post Masters experience with at least two years of related experience 

 Demonstrated interpersonal/verbal communication skills

 Demonstrated written communication skills 

Ability to operate with limited direction 

Ability to multi-task

 Attentive to detail

Licenses, Registrations, and Certifications Pref:  PA License (LSW or LCSW) 

• Identifies patients who would benefit from social work services in the divisions of Ortho Trauma and Trauma Surgery within the limitations of the patient’s support system. Responsible for contributing to the patient’s treatment plan through an understanding of social, psychological, and/or environmental needs related to the impact of injury and need for surgical assessment and care. Will provide trauma-informed intervention, outreach, and case management. While individual client needs will vary, common objectives may include trauma recovery, life goal setting, behavioral change, and increasing connections to school, social supports and social services. Additionally, the SW will provide assistance in navigating medical, legal and financial issues related to the patient’s injury. The SW will need to effectively collaborate with a broad interdisciplinary team and ensure adherence to established plans and interventions within patient/family and health care team across the continuum of care.