Social Worker - Full Time

Hospice of Santa Cruz County Scotts Valley, CA
The Hospice Social Worker is a member of the Interdisciplinary Team responsible for the co-case management of hospice patients and families. In collaboration with patient/family, physician and interdisciplinary team, develops and coordinates an individualized Plan of Care (POC) that reflects patient/family centered goals related to Safe & Comfortable Dying, Self-Determined Life Closure, and Effective Bereavement. Also addresses the multiple psychosocial issues that affect Hospice patients and their families/caregivers.

Essential Responsibilities

Patient and Family Care/Case Management

* Recognizes the patient and family as a "unit of care"

* Develops an individualized documented plan of care reflecting patient/family goals and provides social work services as outlined in the plan of care

* Identifies and monitors potential psychosocial hot spots.

* Provides co-case management support for issues related to care giving, advance directives, funeral planning, community resources and insurance benefit oversight

* Provides co-case management support for issues related to grief and loss, family dynamics and psychosocial history

* Collaborates with IDG regarding changes in patient status and POC

* Exercises professional expertise in managing and coordinating care between and among involved parties in home, SNF and RCFE setting

* Exercises good clinical judgment in the performance of all duties

* Understands and properly utilizes changing network of community resources

* Respects patient right to self-determination and acts as an advocate within the context of the vision, mission, values and ethical standards of HSCC.

* Assists Admission department with resourcing, assessment, information and registration process as requested

* Insures documentation is accurate, organized, legible, and a complete reflection of services provided as well as an interdisciplinary approach to care. Utilizes only approved abbreviations to ensure clarity of documentation

* Demonstrates the ability to articulate the parameters of hospice care and services

* Demonstrates the ability to work with patients/families under stress and in crisis

* Demonstrates understanding of Hospice Medicare/Medi-Cal Benefit and third party payors

* Demonstrates professional demeanor, tact, and respect in dealing with all patients, families, staff and volunteers

* Responds with flexibility to the changing needs within the assigned caseload

* Participates in rotation of weekend and holiday Social Work coverage as needed/requested

* Performs other related job duties as assigned by Supervisor



* Master of Social Work degree required from a school of social work accredited by the Council on Social Work Education.


* Minimum of 1 year of Social Work experience in a healthcare setting required

* Prefer previous experience in hospice or other end-of-life care and services

* Solid experience and/or aptitude with computer systems and electronic medical record systems and charting

Skills Desired

* Strong verbal and written communication skills

* Skilled in tact and diplomacy

* Capable of bringing appropriate level of sensitivity and compassion to patients/families facing terminal illness, death and bereavement

* Understands how to hold and apply appropriate boundaries for care

* Knowledge of community social work services, resources and operational standards

* Understanding of all applicable laws and regulations related to social work licensing

* Understands and utilizes solid ethics in decision making and activities

* Bilingual in English/Spanish highly desirable

Certifications, Licenses, Registrations

* LCSW or related license desirable but not required

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