Acute Social Worker-LICSW

Fairview is seeking a full-time (1.0 FTE) Kidney Transplant Social Worker to join our transplant team. This role provides comprehensive psychosocial support to kidney transplant patients throughout the continuum of care, working in both the outpatient setting at the Clinics and Surgery Center and the inpatient setting at M Health Fairview University of Minnesota Medical Center in Minneapolis. The typical schedule is Monday through Friday, 7:30 a.m. to 4:30 p.m., with an every-sixth-weekend rotation and one holiday commitment per year.

The acute social worker works on-site with the interdisciplinary teams including providers, physical therapists, nurses, dieticians, chaplains and pharmacists to assist patients and families in navigating through their hospitalization. The acute social worker completes psychosocial assessments, care planning/ progression and creates comprehensive discharge plans from the hospital. The social worker is patient facing, responds to crisis situations, manages patient and family expectations, creates solutions to identified discharge barriers and aims to reduce length of stay and prevent avoidable hospital readmissions.

Responsibilities

• Attends daily in person interdisciplinary care team rounds
• Conducts thorough psychosocial assessments with patients and/ or their surrogate decision makers
• Helps the care team navigate and mediate complex psychosocial dynamics
• Is well versed in the surrogate decision maker policy and assists care team members with identifying surrogate decision makers according to the policy
• Communicates frequently with the interdisciplinary team to ensure continuity and effective coordination of care
• Provides emotional support and counseling surrounding adjustment to sudden illness, grief/bereavement and end of life planning
• Addresses social determinants of health and assists with connecting patients to needed resources in the community such as chemical dependency treatment, domestic violence resources, housing stabilization services, mental health services, food shelves, transportation, financial assistance etc.
• Arranges and facilitates in person care conferences as needed to support patients and their families surrounding navigating complex medical decision-making processes/ goals of care
• Documents all interactions thoroughly and timely following established department standard work
• Serves as the expert in system adult and child protection reporting policies
• Collaborates with patients, families and interdisciplinary teams in developing an individualized discharge plan based on age, social and cultural considerations, clinical diagnoses, level of functioning and other relevant needs
• Participates in hospital initiatives and projects to reduce length of stay and related barriers which may include collaborating with providers for clinical adjustments in care
• Assists with ensuring the hospital is in regulatory compliance for care management related conditions of participation
• Assists with efforts to improve patient flow in a high-capacity hospital setting
• Works in a fast-paced hospital environment
• Effectively re-prioritizes competing time sensitive job demands
• Demonstrates the ability to advance evidence-based practice by utilizing standards, guidelines and pathways for care delivery
• Incorporates data and information into practice to continually improve care and practice to enhance patient outcomes
• Supports site and system quality initiatives
• Provide age appropriate short- and long-term therapeutic interventions
• If a licensed supervisor, provide clinical supervision as requested (site dependent)
• Potential opportunity to facilitate a support group (site dependent)

Required Qualifications

• Master of Social Work
• 1 year Experience working in a healthcare or related setting
• LICSW Masters Degree Clinical or Provisional LICSW State of Minnesota Upon Hire

Preferred Qualifications

• 3 years Experience working in a healthcare or related setting