Reports To:                 Director of Patient Family Services

Status:                         Salaried Exempt

FT, PT, PRN:              Full-time

Shift:                           M-F 8:00AM-4:30PM

On Call Rotation:        varies (nights, weekends, holidays)

Location:                     Travels Locally to visit patients in the communities of Haywood, Buncombe, and Madison counties

Provide social work services and support that ensures the patient and their family/caregiver receive psychosocial services according to the standards of Four Seasons Compassion for Life mission statement, policies, and procedures. Manages the social work care for an assigned caseload of hospice patients with varying acuity and needs in a variety of settings. 

• Responsible for performing initial and ongoing psychosocial assessments of patients/family/caregiver with a holistic perspective that incorporates identification of support systems and barriers to care. 
• Implement a plan of care for each assigned patient/family/caregiver unit and evaluation of that plan of care
• Serve as liaison to community health, welfare, and social agencies and make referrals to appropriate agencies on behalf of the patient and family.

• Contribute to patient and family counseling and education with regards to family systems/dynamics and coping methods

• Assist client/family/caregiver with determining health care goals and grief and loss goals.
• Address advocacy needs for patients/families/and organization.
• Responsible for organizing/facilitating the discharge of patients. 
• Actively participate in IDG team meetings for development and evaluation of the patient’s plan of care
• Evaluate the financial needs of each patient/family and make appropriate interventions for financial assistance.
• Assist the family/caregivers in making final arrangements prior to or at time of patient’s death.

• Knowledge of Federal, State and Local regulations and Medicare Conditions of Participation
• Knowledge of HIPAA privacy rules and regulations
• Knowledge of electronic medical records systems
• Expertise in discharge planning
• Knowledge of Hospice Services to include Hospice Medicare Benefit

• Demonstrate basic data entry skills

• Demonstrate excellent organization skills
• Demonstrate excellent interpersonal skills
• Demonstrate excellent written and oral communication skills
• Ability to work under pressure to meet deadlines
• Ability to take initiative and utilize innovative techniques and ingenuity
• Ability to interact with various departments throughout the organization
• Ability to work flexible hours, if needed
• Ability to participate as a team player to coordinate projects
• Ability to plan, prioritize and coordinate multiple projects

Education:       

Experience: 

Licensures & Certifications: (if applicable)

• Valid NC, Clinical Social Worker license (LCSW) preferred
• Valid driver’s license and proof of automobile insurance

• Walking, standing, sitting, bending, reaching, twisting, crouching/squatting, kneeling
• Flexion/Extension of arms/wrist
• Hand dexterity to include gripping, pushing/pulling and writing

• Perform duties in compliance with Medicare Condition of Participation
• Participate in the coordination of the patient’s hospice care in accordance with professional standards of practice.

• Practice within the scope of license, certification or registration, where applicable, and as required by law and regulation.
• Develop and maintain professional relationships with all members of other teams involved in client’s care.
• Demonstrate the ability to function in a variety of care environments, including home settings, skilled nursing facilities, assisted living environment, etc.
• Evaluate bereavement/pre-bereavement needs of client/family/caregiver and develop bereavement plan of care based on that evaluation.
• Assist patients and caregivers in understanding the levels of care and the financial implications of each level of care.
• Responsible for obtaining the necessary information from third party providers for payment.
• Responsible for facilitating internal referrals.
• Assist in providing 24-hour on-call psychosocial services.
• Conduct pre-admission consults and/or facilitate completion of consent forms.
• Attend staff and mandatory in-services meetings, as required.
• Participate in ongoing education and assume responsibility for updating professional skills.
• Practice safety and infection control methods
• Perform other, yet similar duties as assigned.