Social Worker – Open for Part-Time and Full-Time (2023)

Gathers information and conducts pre-admission screening of individuals seeking admission to the facility, including persons with mental illness and mental retardation, according to facility admission criteria, as assigned.

Completes and updates social service assessments for assigned residents as part of the comprehensive resident assessment process. Assessments identify residents with current needs for social service interventions to improve or maintain functional abilities and those residents at risk of psycho-social deterioration.

Completes assigned sections of the RAI (MDS, Triggers, RAPs) in a timely manner per the established schedule.

Act as Care Plan Coordinator as assigned.

Interviews residents, interested family members, legal representatives, and significant others to obtain and update information needed to develop individualized plans of care and to protect and promote residents' rights.

Works cooperatively with members of the interdisciplinary team to develop, implement and evaluate the plan of care. Attends care conferences as assigned. Communicates resident concerns and responses to interventions to interdisciplinary team members and direct care staff.

Audits clinical records of residents on a regular basis to monitor resident responses to care and treatment and to identify concerns about Resident Rights. Acts as a role model for direct care staff in matters of protecting and promoting residents' rights. Suggests approaches and methods of interacting with residents that maintain and enhance the person's dignity and individuality. Assists direct care staff with behavioral assessments and the development of alternative approaches that minimize or eliminate the use of physical and chemical restraints.

Provides or arranges for social work counseling services as needed to attain or maintain the highest practicable mental and psycho-social well-being.

Records progress notes in the clinical record including subjective findings, objective symptoms, observations of behavior, interventions provided to residents, and residents’ responses to interventions.

Identifies ways to accommodate residents’ choices, preferences, and customary routines. Includes these approaches in the plan of care and gives this information to direct care staff.

Gives residents and prospective residents, family members, and legal representatives information about the resident’s rights under state law to make choices about healthcare decisions and about eligibility for Medicare and Medicaid benefits.

Provides information, about community resources for legal, financial, mortuary, and other services. Intervenes on behalf of residents as needed. Assists with applications for benefits and procurement of services, clothing, and personal care items from community sources outside the facility. Examples include, but are not limited to dental/denture care, pediatric care, eye care, hearing services, assistive devices, and equipment, talking books, absentee ballots, and transportation services.

Maintains ongoing contact with interested family members, legal representatives with consent of residents to inform them of changes in condition, discharge planning efforts, and to encourage family participation in developing a plan of care.

Evaluates assigned residents for discharge potential. Provides discharge planning services when discharge is anticipated that reflect the residents’ and family's preferences for care, coordination of post-discharge care and services, including transportation, and how the resident will access and pay for services. Prepares discharge summary for resident’s record that is available, with the consent of the resident, for release to authorized persons and agencies.

Assists Director of Social Services with preparation for long term care survey. Conducts compliance rounds, attends survey training and interacts with state surveyors as instructed.

Attends in-service education as assigned. Applies information to job tasks.

Participates in fire and disaster drills. In event of an emergency, carries out assigned duties to assure resident safety.

General Responsibilities

Must work the days and hours necessary to perform all assigned responsibilities and tasks. Must be available (especially during regular business hours or shifts) to communicate with supervisors, customers, vendors, and any other person or organization with whom interaction is required to accomplish work and employer goals.

Must be punctual and timely in meeting all requirements of performance, including, but not limited to, attendance standards and work deadlines; beginning and ending assignments on time; and scheduled work breaks, where applicable.

Must maintain courteous, professional, and effective working relationships with employees at all levels of the organization.

Must develop and maintain courteous and effective working relationships with clients, vendors, and/or any other representatives of external organizations.

Must assume responsibility for providing timely, appropriate responses to requests/suggestions/complaints or refer such comments to the appropriate person. When referring requests/suggestions/complaints to another individual, the employee must follow up in writing with the individual and must maintain an accessible copy of the referral or follow company guidelines.

Must communicate information and state problems or challenges to be resolved in a clear, concise, courteous, non-discriminatory, and professional manner, and be able to provide clarification, as necessary.

Must show respect for the opinions of others and behave in such a way as to ensure an atmosphere free of needless interruptions, difficulty, and/or discrimination.

Must receive and provide clear, constructive feedback regarding work performance (to/from individuals or groups) and be able to clarify, as necessary.

Must handle in a constructive, non-disruptive manner, the multiple businesses, organizational and interpersonal changes or stresses that may exist in the employee’s work, work processes, dealings with other personnel, and supervision (provided or received). (“Work processes” include but are not limited to, how work is performed, supervised, or distributed; how problems are solved; and how decisions are made.)

Must be sufficiently adaptable to accept and perform in timely and effective manner work assignments that are outside the normal (day-to-day) routine.

Must adapt, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished.

Performs related duties as required. (Related duties as required are duties that may not be specifically listed in the class specification or position description but are within the general occupational series and responsibility level typically associated with the employee’s class of work.)