Medical Social Worker- Home Care

Job Summary

Medical Social Worker – Home Care (Open) – Full time, Shift: Day/Evening (United States).

• Conduct psychosocial assessments, interviews, and/or treatments and discharge planning to patients and families to assist them in coping with hospitalization, illness, diagnosis, and/or life situation.
• Work collaboratively with other members of the health care team, community resources, regulatory agencies and third‑party payers to facilitate transition of patients through the organization while maintaining high quality services.
• Develop and coordinate comprehensive care transition plans with the interdisciplinary team, ensuring appropriate resource utilization.
• Regularly reassess care plans and adjust as needed, coordinating face‑to‑face with patients whenever possible.
• Maintain up‑to‑date knowledge of benefit plans, regulatory guidelines, and resources for cost‑effective care.
• Ensure timely, accurate, and confidential documentation, meeting professional standards and federally regulated timelines for assessments and discharge plans.
• Stay current with social work and healthcare developments, attending department training and educational sessions as required.
• Provide supervision, teaching, and training for staff and students as needed.
• Actively participate in interdisciplinary meetings and maintain effective communication with all care team members to ensure timely and appropriate care transitions.
• Advocate for patients and provide therapeutic interventions to support their adaptation to illness or life changes.
• Support patients and families by addressing emotional and coping challenges, and providing education related to their condition.
• Participate in performance improvement initiatives, adhering to productivity measures and utilizing data to monitor and enhance patient care.
• Comply with departmental policies and procedures while identifying and escalating avoidable delays in care transitions.

• Master's degree from an accredited school of Social Work.
• Minimum of two years of social work experience in a health care setting (preferred).
• Effective interpersonal, communication, and team‑working skills.
• Advanced knowledge of social work theory and practice, proven expertise as a clinical social worker, crisis intervention skills, critical thinking and creative problem‑solving.
• Oral and written communication skills, analytical skills, cultural competence, integrity, teamwork, courteousness, and willingness to work as an integral member of a multi‑skilled team.
• Successful completion of orientation and competency validation for the position.

Carilion Clinic is an Equal Opportunity

Employer:

We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status. Carilion is a Drug‑Free Workplace.

• Comprehensive Medical, Dental & Vision Benefits.
• Employer‑Funded Pension Plan, vested after five years (Voluntary 403B).
• Paid Time Off (accrued from day one).
• On‑site fitness studios and discounts to Carilion Wellness centers.
• Access to our health and wellness app, Virgin Pulse.
• Discounts on childcare.
• Continued education and training.