Social Worker MSW - Hospice

Per Diem Hospice Social Worker (MSW) II: Empowering Patients and Families in Home Care & Hospice

Are you a compassionate and skilled Social Worker ready to make a significant impact on patients and families? Home Health & Hospice is seeking a dedicated Per Diem Medical Social Worker (MSW) II to join our interdisciplinary team supporting our patients in both the McClure Miller Respite House and in their homes. In this vital role, you'll provide comprehensive social work and care management services, helping to navigate psychosocial challenges and empower individuals to achieve their health and end-of-life care goals.

What You'll Bring

We're looking for an empathetic and experienced professional with a strong clinical foundation.

Education & Experience:

• Master’s Degree in Social Work (MSW) is required.
• Two years of relevant experience in social work, or a combination of education and experience that provides comparable knowledge and skills.
• Healthcare experience is preferred.

License & General Requirements:

• Vermont LMSW Licensure is required; LICSW is preferred.
• Skilled in building rapport, providing supportive counseling, and conducting sensitive medical interviews.
• Able to work cooperatively and productively with both internal teams and external partners.

Key Knowledge & Special Skills:

• Strong understanding of social work and care management standards of practice, including insurance structures, Medicare/Medicaid regulations, clinical guidelines, and quality issues related to home health and hospice care.
• Insight into barriers and resources for diverse populations.
• Expertise in crisis intervention for high-risk situations like abuse, neglect, environmental stressors, suicide risk, guardianship issues, and unsafe home environments.
• Excellent facilitation skills and understanding of team dynamics.
• Demonstrated strong verbal and written communication skills.
• Proficient in explaining complex medical problems and treatments clearly and understandably, while identifying communication barriers.
• A genuine desire to build honest and trustworthy relationships with all individuals.
• Ability to assess and provide comprehensive case management services throughout the continuum of care, utilizing principles of human growth and development to help patients and families cope with illness, psychosocial challenges, loss, and grief.
• Awareness of your own culture, beliefs, identities, values, and biases, and how they influence your interpersonal style.
• Working knowledge of medical and mental health diagnoses, disabilities, treatment procedures (acute, chronic, traumatic illnesses, substance abuse), common medications, and medical terminology.
• Clear understanding of mandated reporting requirements for suspected abuse and neglect of vulnerable adults and children.
• For Hospice SW specific duties: Ability to perform hospice admissions, potentially supervise day-to-day tasks of other interdisciplinary team members, and provide bereavement support in accordance with hospice conditions of participation.

How You'll Make a Difference: Your Impact in This Role

As an MSW II, you'll be at the forefront of patient-centered care, providing vital support and coordination.

Performance Standards:

• Deliver patient-centered and family-centered services, considering readiness, literacy, health literacy, and cultural factors to ensure effective education and empowerment for managing care.
• Conduct comprehensive initial in-home psychosocial assessments, evaluating patients' circumstances, problems, needs, and emotional adjustment to illness within their medical context.
• Accurately document in a timely manner all relevant assessment information, including medical and psychosocial history, response to illness, belief systems, financial situation, environment, developmental level, and functional/legal status.
• Utilize assessments to facilitate patients' maximum use of treatment, promoting independence through skilled service, treatment planning, crisis intervention, and counseling within your professional scope.
• Assist with a home visiting caseload of diverse patients with complex needs, including admitting clients, scheduling visits, identifying resources, and collaborating with patients, caregivers, families, and multidisciplinary teams to develop and align care plans with medical needs.
• Provide crucial care coordination in conjunction with the interdisciplinary team and external organizations, government agencies, and healthcare providers, with a strong emphasis on educating all parties about the unique needs of patients dealing with illness, disabilities, palliative, and end-of-life care.
• Coordinate and may lead patient care conferences, establishing goals and anticipated outcomes aligned with care plans.
• Stay current with regulatory and legal requirements, including HIPAA, Medicaid, and Medicare Conditions of Participation.
• Develop and maintain strong relationships with community partners and resources.
• Facilitate and/or participate in multidisciplinary care conferences, rounds, or family meetings.
• Apply expertise in assessing, planning, intervening, monitoring, and evaluating clients.
• Assess, identify, and recommend interventions based on patient/family resources and obstacles for complex psychosocial and medical situations.
• Collaborate effectively as part of the interdisciplinary team, utilizing your skills to facilitate appropriate care, assess and intervene for patients and families, and make necessary referrals.
• Under the clinical supervision of an MSW III or MSW Lead, triage and coordinate care for complex medical and psychosocial issues.
• Consult with social work leadership for information exchange, care coordination, case consultation, and unusual situations requiring additional intervention.
• Attend required meetings and collaborations to assist in updating policies/procedures and quality improvement activities.
• Facilitate a respectful and collaborative environment in response to conflict and change.
• Perform any other related duties as designated by your manager.

Working Conditions & Physical Requirements

This role involves a dynamic environment, requiring adaptability and physical capability.

Working Conditions:

• Regular travel is required.
• Work may take place in community-based settings, clients’ homes, and outdoors.
• You may work during non-business hours.
• You might encounter:
  • Emotionally upset or hostile clients, family members, visitors, and staff.
  • Stress inherent in a demanding profession.
  • Potential exposure to blood-borne pathogens.
  • A variety of environmental exposures such as inclement weather, animals, firearms, tobacco use, dust, and other client-based activities and preferences.

If you are a dedicated MSW ready to provide essential support and coordination in a meaningful role, we encourage you to apply and join our team!