- Consistently exhibits behavior and communication skills that demonstrate Tandigm Health’s commitment to superior customer service, including quality, care, and concern for each and every internal and external customer.
- Performs in-home psychosocial evaluations of patient’s physical, social and emotional functioning. This may include financial and family support as needed.
- Consistently exhibits behavior and communication skills that demonstrate Tandigm’s commitment to our mission and values.
- Develops a treatment plan or plan of care in collaboration with the care management team.
- Provides community resource information and performs referral and liaison activities as necessary for the patient’s ambulatory care.
- Acts as a consultant to patients requiring information on Advanced Directives.
- Participates as appropriate in weekly patient care rounds for patients.
- Assists patients and their families with transitions of care out of post-acute care settings for patients with complex discharge needs.
- Participates on an assigned basis in educational training for employees and providers related to the psychosocial aspects of physical and emotional illness/disability.
- Acts as a resource to other Social Workers within the organization on difficult to manage cases.
- Perform patient evaluation and documentation within 48-hours.
- Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.
- Master’s degree in Social Work (MSW required) from an accredited school of social work education with a specialization in clinical practice
- Licensed or registered in the state of practice as required by state regulations.
At least one-year experience in a hospital or other healthcare setting, 3 or more years preferred
Knowledge, Skills & Abilities
- Demonstrate commitment to social work values and code of ethics
- Experience with geriatric or end of life care preferred
- Proficiency in Microsoft office and ability to type 25wpm
- Deep knowledge of community resources and commitment to innovation
- Ability to interface effectively with culturally diverse patients and communities, providers, management, and employees of the organizations.
- Ability to exercise objectivity and good judgment relating to difficult and emotionally-charged situations.
- Strong time management and organizational skills in order to meet documentation guidelines