Medical Social Worker - PRN Home Health

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Professional Ocala, FL, US

At Elite Home Health, we believe healing happens best  a Medicare-certified home health agency serving communities across Florida, we provide high-quality, compassionate care that helps patients recover, maintain independence, and improve their quality of life.

We are seeking compassionate Medical Social Workers who are dedicated to supporting patients and families through the emotional, social, and environmental challenges that impact health and recovery.

If you are passionate about advocacy, patient support, and connecting individuals to meaningful resources, we would love to meet you.

The Medical Social Worker (MSW) provides skilled social work services to patients in their homes in accordance with physician orders, the plan of care, agency policies, and applicable state and federal regulations.

The MSW assesses patients’ psychosocial needs, provides counseling and support, and connects patients and families with community resources to promote safety, independence, and overall well-being.

This position reports to the Director of Nursing (DON), Clinical Manager, or designated clinical leadership. The MSW functions as part of the interdisciplinary care team and collaborates with nursing, therapy, and administrative staff to support patient care.

The Medical Social Worker performs services within the scope of applicable licensure or qualifications, Medicare Conditions of Participation, physician orders, and agency policies. This role includes assessment, counseling, care coordination, and resource connection, but does not provide medical or nursing care.

• Perform initial and ongoing psychosocial assessments of patients and families
• Identify social, emotional, financial, and environmental factors impacting patient care
• Participate in development and implementation of the interdisciplinary plan of care
• Assist with discharge planning and transition of care needs

• Provide counseling and emotional support to patients and families
• Assist patients in coping with illness, disability, and life changes
• Support patient rights, dignity, and autonomy in care decisions
• Address family dynamics and caregiver stress as appropriate

• Connect patients and families with community resources and support services
• Assist with referrals for financial assistance, housing, transportation, and other needs
• Coordinate with external agencies and service providers as appropriate
• Advocate for patient access to necessary services

• Complete timely and accurate documentation of assessments, interventions, and patient interactions
• Maintain compliance with Medicare requirements, state regulations, and agency policies
• Ensure documentation supports the patient’s plan of care and service needs
• Communicate with physicians, nurses, therapists, and interdisciplinary team members regarding patient needs
• Participate in care conferences, case discussions, and discharge planning
• Attend required in-services, staff meetings, and training sessions

• Master’s degree in Social Work (MSW) from an accredited program required. Current licensure as a Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW), as required by state regulations, required. Minimum of one (1) year of experience in a healthcare setting required; home health, hospice, or medical social work experience preferred.
• Home health, hospice, or medical social work experience preferred
• Current CPR certification required
• Valid driver’s license, reliable transportation, and auto insurance
• Ability to pass background screening and all compliance requirements

• Strong assessment and counseling skills
• Compassionate and patient-centered approach
• Excellent communication and interpersonal abilities
• Resource coordination and advocacy skills
• Ability to work independently in a home health setting
• Strong documentation and organizational skills
• Commitment to patient dignity, privacy, and confidentiality

• Frequent travel to patient homes within assigned territory
• Ability to sit, stand, and navigate home environments as needed
• Ability to communicate effectively with patients, families, and care teams
• Ability to use electronic documentation systems
• Ability to work in homes with varying accessibility conditions

Work is performed in patient homes and community settings with exposure to variable environmental conditions, including pets, smoke, infectious diseases, and weather-related travel conditions.

We know great professionals have options. Here’s why they choose Elite:

• Competitive compensation
• Supportive leadership and…