• Responsible for providing individuals, families, and groups with the psychosocial support needed to cope with chronic, acute, or terminal illnesses.
• Knowledge of and communication with referral sources; providing hospital and program information to individuals, agencies, facilities, and professionals.
• Assessing and triaging an individual’s mental health and/or chemical dependency status; assessing patient safety and level of care recommendations to the physicians(s).
• Identify discharge needs and arrange for comprehensive services for patients following discharge from the hospital.
• Advocate for clients or patients to resolve crises.
• Identify environmental impediments to client or patient progress through interviews and review of patient records.
• Monitor, evaluate, and record client progress according to measurable goals described in treatment and care plan.
• Explain to patients and/or families their insurance benefits, pre-certification of patient care and completing all admission requirements.
• Communicating patient safety concerns and pertinent patient information to unit nursing staff and documenting all necessary information.
• Conduct stroke assessment for newly diagnosed patients to determine one’s level of functioning.
• Manage monthly and weekly statistics for the Ryan White Program.
• Act as a field instructor for students that are actively seeking their MSW and NP License.
• Facilitate weekly Multidisciplinary team meeting.
• Lead morning team planning meetings.
• Provide supportive counseling and coordinated multi-discipline strategies with the use of available community resources to individuals living HIV and AIDS on a Specialized Immunology Service.
• Link homeless patients to adequate housing that will afford them with the opportunity to recuperate in a safe environment.
• Facilitate a timely and appropriate discharge plan while remaining compliant with all laws and regulations.
• Advocate for patients to create a comprehensive and safe discharge plan.
• Connect patients and families to necessary resources and supports in the community; provide psychotherapy, supportive counseling, or grief counseling; and help patients to expand and strengthen their network of social support.
• Conduct bio psychosocial assessments to determine patients’ needs and ongoing issues.
• Plan and conduct programs to combat social problems, prevent substance abuse, or improve community health and counseling services.
• Use the following interventions for patients i.e. crisis intervention and motivational interviewing.
• Document progress notes that relate to each patient’s care plan within policy time frame.
• As a preceptor, I mentor and coach social workers by guiding and directing them through the clinical practice role. I also have newly hired staff shadow me as I provide clinical practice skills with in and out patient clients, families and staff.
• Utilize case management training modules and other clinical tools to enhance best practice.
• Perform quality reviews of staff documentation to ensure compliance with regulatory standards.
• Frequently participate in preceptor meetings and skill development, attend and participate in yearly refresher courses/CEUs to increase my skills as a preceptor.