The Hospice and Palliative Care department is seeking a Social Worker. In this position you will be responsible for identifying patients who have complex psycho/social needs, require assistance with eligibility determination for social programs funding sources and who may qualify for community assistance from a variety of special funds and agencies. In addition, the Hospice /Palliative Social Worker operates as the mental health professional of the team. All interventions are aimed at improving Quality of Care/Life and decrease complications and readmissions. The HPSW offers crisis intervention to patients and families with psychosocial needs and coordinates and facilitates the development of the Plan/Goals of care for all patient populations served by home care teams. This role will receive referrals and consultations for patients from at risk populations from interdisciplinary team members, including physicians, Case Managers, staff nurses and other members of the care team, in addition to case findings. Social work interventions and services may be assigned in person, via phone, and/or via telehealth means.
Type of Opportunity: Full Time FTE: 1.0
Work Schedule: Days
Sign on and Relocation Bonuses available to qualified candidates
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Provides Home Health, Hospice IP/OP, and Palliative Care social work across outpatient and inpatient settings.
Based on the referral, consultation, or case finding, assess patients and family�s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope. *Completes comprehensive psychosocial assessment.
Provides psychosocial interventions.
As active participant of IDT contributes to and manages the patient plan of care. Provides strengths-based, person and family centered care. *Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability, provides psychoeducation.
Provides supportive counseling to patients / families experiencing and/or anticipating issues to adjusting to illness, catastrophic diagnosis, changes in living situations and bereavement.
Intervenes with patients demonstrating complicated grief and explores bereavement related to possible death and multiple aspects of loss and adaption along the continuum of care.
Provide anticipatory guidance.
Provides non-pharmalogical pain and symptom management, reinforces patient and family personhood and coping as they negotiate complications with chronic illness and end of life.
Assist Hospice Chaplain with developing plan of care.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Facilitates family meetings.
Participates in discharge planning activities in collaboration with other department staff for patients, to ensure a timely discharge and to provide appropriate linkage with post-acute providers.
Works with families exhibiting complex family dynamics that impact directly on patient care and discharge.
Provides clinical guidance and consultation to interdisciplinary primary teams, including social workers and case managers, prompting continuity of care as well as safe and comprehensive care coordination and discharge planning as indicated,
Educates patient/family and interdisciplinary team regarding post-acute options and addresses issues of choice.
Provides intervention in child abuse/neglect, domestic violence, guardianship (temporary/ permanent), foster care, adoption, mental health placement, advance directives, adult/elderly abuse, child protection and sexual assault as appropriate
Participates in on call rotation as required by department.
Supervise and mentor Social Workers enrolled in Master level programs to fulfill practicum clinical hours for licensure and diploma requirements.
All other responsibilities assigned by supervisor.
Coordinates volunteers and provides bereavement services to patients/families and community.
Volunteer Services
Serves as the hospice volunteer coordinator to be responsible for the following:
Recruit and retain volunteers for Hospice.
Provide training, education, and orientation to new Hospice volunteers.
Coordinating with HR to ensure volunteers are trained and receive appropriate background checks and health
immunizations.
Hold monthly meetings for education and retention of current volunteers.
Facilitate assessment for volunteer placement in patient homes.
Coordinate volunteers in pt homes and assist with communication between volunteers and IDT members.
Community outreach events to educate community regarding the needs for Hospice volunteers and Hospice education.
Managing Desk File for Hospice volunteers in compliance with Hospice Conditions of Participation.
Managing and recording hospice volunteer hours worked to reach 5%.
Monthly education to current Hospice volunteers to demonstrate competency.
Assist Hospice Chaplain with developing plan of care.
Bereavement Services
Serves as the Bereavement Coordinator as needed to be responsible for the following:
Bereavement assessment post-mortem.
Develop bereavement plan of care based on assessment.
Bereavement visits and phone calls based on bereaved plan of care.
Supervising bereavement program and/or volunteer with bereavement mailings.
Make referrals to outside sources of support for intensive bereavement counseling.
Assist with adjustment and transition to survivors of bereaved.
Performs other duties as assigned.
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About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system comprised of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1,200 providers and nearly 3,500 nurses.
Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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