Social Worker

Conduct psychosocial and bereavement assessments within five days of admission and collaborate with the Interdisciplinary Team to formulate the Plan of Care. Discuss the plan with admitting nurses daily, perform regular social work visits, and document interventions and outcomes in the Electronic Medical Record. Assist patients and families with insurance needs, including Medicaid enrollment, coordinate volunteer services, and facilitate discharge planning when hospice care is no longer appropriate. Participate in IDT meetings, review and update the plan of care, and communicate changes in patient status to the attending physician. Deliver or supervise social services, explain advanced directives, and assist with funeral arrangements while maintaining a current community resource guide. Work in an on-call rotation for after-hours visits and crises, reporting emotional, social, or financial changes to the physician.