Community Outreach Social Worker

Community Outreach Social Worker

The Outreach Social Worker is responsible for providing comprehensive social services which assist patients, clients and their families to find practical ways of overcoming social, emotional and environmental barriers to optimum functioning and attainment of health. The Community Outreach Social Worker alters activities/behaviors to reflect and ensure adequate care and services appropriate to the age of patients served (i.e. neonatal, infant, pediatric, pre-school, school age, adolescent, adult and geriatric).

Essential Functions and

Responsibilities include:

• Interviewing patients and their families in an outpatient and community setting to identify and address social needs
• Managing assignment of patients referred by the intensive care manager, ensuring that 100% of patients with an identified need have been assessed and evaluated
• Building rapport with patients and their families and relaying medical concerns needing addressed to the intensive care manager
• Initiating social service plans for patients/clients through professional collaboration with intensive care managers, primary care providers and health care personnel utilizing screening questionnaires, diagnostic assessments and individualized therapeutic care plans
• Assessing patient's needs, situation, strengths, and support networks to determine their goals
• Serving as a liaison between patient/family and healthcare personnel to ensure necessary care is provided promptly and effectively
• Assisting patients and families in understanding the implications and complexities of their medical situation and its impact on their current lifestyle
• Advocating on behalf of vulnerable patients and participating in assessing and evaluating their need for health care services and community programs; and assisting them with getting connected to those services
• Providing direction in the selection, analysis, summarization and presentation of patient/client and related information for service delivery planning, case conferences and professional consultation
• Providing complex social service intervention to individuals, families and groups ranging from diagnostic assessment, short term counseling, crisis intervention, community resource referrals, client advocacy, support, outreach, follow-up and intra/inter agency consultations
• Educating and informing patients of community resources that are located within their neighborhood community
• Providing education and training to introduce or improve coping skills of individuals and families
• Documenting services rendered in the medical record
• Conducting social service orientation for physicians, community health workers, nurses, and students as appropriate
• Utilizing problem-solving skills to identity and facilitate problem resolution in team functioning
• Participating in staff meetings and education programs for staff and community agencies as assigned
• Assuming responsibility for continuous professional self-development
• Collaborating with multi-disciplinary team members to facilitate the coordination and delivery of services that assures appropriate treatment plans and continuity of care
• Initiating advocacy/liaison role for patients/clients in referrals to and from community agencies: collaborating with agency and hospital personnel in referral activities: cultivating referral resources
• Interpreting impact on client functioning of environmental conditions and family interactions through home visits and outpatient encounters

Job Requirements include:

• Minimum of a Master of Social Work with at least 2 years of experience in a similar environment or Active licensure as a Social Worker (LSW) or Clinical Social Worker (LCSW)
• Social service experience in a healthcare setting dealing with pediatric, adolescent, adult and geriatric patients is preferred
• Bilingual preferred
• Effective communication skills
• Knowledge and skills necessary to provide care appropriate to the age of patients served
• Ability to use age appropriate communication and skills detailed in the department/area/unit job specific/age specific competencies
• Analytical, psychosocial assessment and counseling skills
• Knowledge of pertinent State/Federal laws and regulations, community systems and resources
• Ability to work cooperatively with multi-discipline teams in situations requiring a high degree of flexibility, creativity, initiative
• Ability to apply social service techniques/principles including evaluation, intervention, and case management
• Ability to perform duties independently under…