Medical Social Worker (MSW) – Per Visit Position
The Medical Social Worker (MSW) provides medical social services to patients and families receiving skilled home health care under the direction of a physician and in collaboration with the interdisciplinary care team. The MSW assesses the patient's psychosocial needs, develops appropriate intervention plans, coordinates community resources, and supports patients and caregivers in achieving optimal health outcomes while complying with Medicare Conditions of Participation and agency policies.
Employment Status
- Non-Exempt
- Per Visit Compensation
Compensation is based on completed visits and documentation that meets agency, Medicare, and regulatory requirements. Payment is made only for visits that are completed, documented, and submitted within established agency timeframes.
Compensation Schedule
- Initial Comprehensive Psychosocial Evaluation: $per completed visit
- Follow-Up Medical Social Work Visit: $per completed visit
- Discharge Visit (if applicable): $ per completed visit
- Case Conference : $ hourly per attendance
- Mileage reimbursement: Per agency policy
Productivity Expectations
The Medical Social Worker is expected to:
- Complete assigned visits within the scheduled timeframes.
- Submit accurate and complete documentation within 24 hours of each visit or as required by agency policy.
- Maintain communication with the Clinical Manager regarding patient status and scheduling.
- Participate in interdisciplinary team meetings and case conferences as requested.
- Meet quality assurance standards for documentation, patient satisfaction, and regulatory compliance.
Visit Types Initial Psychosocial Evaluation
The initial evaluation includes:
- Comprehensive psychosocial assessment.
- Identification of patient and caregiver needs.
- Evaluation of emotional, financial, environmental, and community resource needs.
- Development of measurable social work goals and interventions.
- Coordination with the interdisciplinary team.
- Patient and caregiver education.
- Documentation supporting the plan of care.
Follow-Up Medical Social Work Visits
Follow-up visits may include:
- Reassessment of psychosocial status and progress toward goals.
- Counseling and emotional support.
- Caregiver support and education.
- Crisis intervention as needed.
- Assistance with community resource referrals and follow-up.
- Coordination with physicians, community agencies, and interdisciplinary team members.
- Evaluation of intervention effectiveness and modification of the care plan when appropriate.
- Documentation of patient response and continued medical necessity.
All services must be provided in accordance with the physician's orders, the individualized plan of care, Medicare Conditions of Participation, state regulations, and agency policies.
Reports To
- Clinical Manager/Director of Clinical Services
Qualifications
- Master's degree in Social Work (MSW) from a school accredited by the Council on Social Work Education (CSWE).
- Licensed as a Social Worker in accordance with state laws and regulations.
- Minimum of one (1) year of experience in a healthcare setting preferred; home health experience preferred .
- Current driver's license, reliable transportation, and proof of automobile insurance.
- Current CPR certification (if required by state or agency policy).
- Ability to pass background screening and meet agency employment requirements.
Essential Job Responsibilities
- Complete comprehensive psychosocial assessments to identify emotional, social, financial, environmental, and community support needs.
- Participate in the comprehensive patient assessment and development of the individualized plan of care.
- Develop and implement medically appropriate social work interventions.
- Provide counseling related to illness adjustment, grief, family dynamics, caregiver stress, and coping strategies.
- Assist patients and families in identifying and accessing community resources, financial assistance programs, transportation services, housing resources, and other supportive services.
- Coordinate referrals to appropriate community agencies and governmental programs.
- Collaborate with physicians, nurses, therapists, home health aides, and other interdisciplinary team members.
- Educate patients and caregivers regarding available community resources and advance care planning when appropriate.
- Participate in case conferences and interdisciplinary team meetings.
- Monitor patient progress and revise interventions as needed.
- Document assessments, interventions, care coordination, and patient responses accurately, completely, and within agency-required timeframes.
- Ensure compliance with Medicare Conditions of Participation, state regulations, accreditation standards, HIPAA, and agency policies.
- Report significant changes in patient condition or psychosocial status promptly to the physician and supervising clinician.
- Promote patient rights, dignity, privacy, and cultural sensitivity throughout care delivery.
Documentation Requirements
- Complete initial psychosocial evaluation within agency-established timeframes.
- Document all patient visits promptly in the electronic medical record HCHB/ Point care .
- Maintain accurate, timely, and complete clinical documentation that supports medical necessity and regulatory compliance.
- Participate in OASIS-related care planning as appropriate.
Knowledge, Skills, and Abilities
- Knowledge of Medicare home health regulations and Conditions of Participation.
- Understanding of community resources and public assistance programs.
- Excellent assessment, counseling, crisis intervention, and care coordination skills.
- Strong verbal and written communication abilities.
- Effective organizational and time-management skills.
- Ability to work independently while collaborating with an interdisciplinary healthcare team.
- Proficiency with electronic medical records and standard computer applications.
Physical Requirements
- Ability to travel to patient homes within the agency's service area.
- Ability to sit, stand, bend, lift up to 25 pounds, and perform routine office and patient care documentation tasks.
- Ability to safely navigate various home environments.
Working Conditions
- Travel between patient residences.
- Exposure to varying environmental conditions found in patient homes.
- Potential exposure to infectious diseases; adherence to standard precautions and agency infection control policies is required.
Performance Expectations
- Deliver high-quality, patient-centered psychosocial services.
- Maintain productivity standards established for per-visit staff.
- Complete documentation accurately and within required timeframes.
- Demonstrate professionalism, ethical practice, confidentiality, and compliance with all applicable federal, state, and agency regulations.
Pay: $41.93 - $46.66 per hour
Benefits:
Work Location: On the road
