POSITION SUMMARY: The provision of medical social work services to patients in their homes under written orders from qualified physicians according to established Agency policies and procedures. EDUCATION/CERTIFICATION: + Master in Social Work from an Accredited College or University. + Must possess a valid license from the State of CT as a Licensed Clinical Social Worker. EXPERIENCE: + Two years’ clinical experience; prefer home care experience. + Possess adequate transportation to carry out the requirements of the job. + Proof of satisfactory automobile insurance with minimum coverage to be determined by Agency policy. ESSENTIAL DUTIES and RESPONSIBILITIES: Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time. Eastern Connecticut Health Network reserves the right to change or assign other duties and responsibilities to this position + List essential duties and responsibilities in descending order of importance Provides social work to patients in their homes in compliance with state and Medicare regulations, incorporating the following: + Completes a comprehensive evaluation of the psychosocial status of the patient/family as related to the patient’s illness and environment and develops a social work plan of care. + Establishes an appropriate plan of care and therapeutic goals with the patient/family. + Provides long-term and short-term planning, community resource planning and counseling. + Identifies patient and family needs for other home and/or community services. + Completes discharge planning/referrals for patient/family. + Completes interdisciplinary team notes. + Documents all services provided according to state and federal regulations, and Agency policy: + Admission assessments are completed in a timely fashion (24 hours from first social work visit.) + All subsequent visits are documented within 24 hours. + Time sheets are completed daily. + Maintains current physician orders and complies with all reporting requirements and third party payers. + Prepares interim and discharge summaries as requested. + Manages caseload in assigned area: + Upon receipt of referral and makes first contact within four working days; hospice cases are contacted within 72 hours. + Remains flexible in daily planning. + Reports any cases to supervisor where goals can not be met or unsafe home situation exists. + Utilizes interdisciplinary approach, attending team meetings and informing primary nurse of client’s progress/status with therapy. + Participates in the development of the interdisciplinary team plan of care on hospice patients, when appropriate. + Develops and maintains sufficient professional skills to meet the needs of patient care: + Attends a minimum of 12 hours of in-service per year. + Participates in self-appraisal and the formation of a plan of self-development. + Projects professional image through attitude and compliance with dress code. + Participates in monthly peer consultation. + Adheres to Agency Corporate Compliance Plan and HIPAA Privacy Plan as per written agreement. + Performs other duties as necessary to support agency programs as assigned by Clinical Supervisor. + Agency committees as requested. + Special Agency or community programs during and/or after regular hours. + Student supervision as indicated. + Abides by agency weekend/holiday schedule for therapists. + Team assignments may change with or without notice based on agency needs.