Social Worker - Outpatient Hospice

Summary

Interviews patients & relatives to obtain social history relevant to patient’s medical problems and assess bereavement risk relative to anticipatory grief and family members’ needs post‑death.

Assists patients with environmental difficulties that interfere with obtaining maximum benefits from medical care. Serves as liaison between medical and nursing staff, patients, relatives, and appropriate outside agencies. Interprets and assists in resolving social problems that relate to medical condition and/or hospitalization.

Interviews patients and family members to obtain information about home environment, family relationships, health history, and patient’s personality traits.

Plans, organizes, directs and schedules spiritual programs and services that meet the needs of patients/families, hospital employees, and medical staff.

Consults with hospital staff regarding hospital ministry; collaborates with members of the hospital care team in identifying and resolving problems.

Acts as a liaison between patient, family, and hospital staff during periods of crisis, e.g., illness, dying, lengthy or difficult surgery.

Assists in developing and implementing the patient’s care plan.

Interprets the nature of illness and prescribed course of treatment to patients and families; communicates family issues to other staff members; participates in planning conferences.

Plans for needed care with nurse practitioner, physician, patient, and family.

Introduces programs designed to meet the needs of the elderly after discharge and makes appropriate referrals and arrangements for services.

Acts as liaison between medical/nursing staff, patients, families, and community, arranging for post‑discharge care and patient’s transportation.

Maintains current, accurate documentation in the client’s medical record.

Adheres to TMC organizational and department‑specific safety, confidentiality, values, policies, and standards.

Performs related duties as assigned.

Assists in developing and implementing the patient’s/family member care plan. Provides individual and group counseling, follows up on critical incident briefings to doctors, ER, and support staff. Provides home counseling if needed, follow‑up telephone calls, and referrals if needed. Develops education component for volunteer training and annual hospice foundation teleconference, prepares and implements all logistics for program needs.

Master’s Degree in Counseling, Social Services or related field and experience in individual and group counseling.

Works with clients and multidisciplinary team to identify discrepancies and barriers to health, wellness, and independence toward health equity.

Assesses and utilizes credible tools to evaluate social determinants of health and develop individualized plan of care for client/family to overcome identified barriers.

Prepares needs assessment, engages team to collaborate services and community resources. Measures identified barriers, records data, and coordinates all efforts to improve health and wellbeing.

Improves understanding of access points for medical care resulting in decreased use of emergency resources, decreased hospital admission, re‑admission, and unnecessary expenditures. Provides education regarding health promotion and disease prevention or exacerbation. Acts as navigator and entry point for marginalized community members to essential life‑enhancing resources. Works with clients experiencing behavioral health and/or substance use/abuse, acting as liaison into BH/SU/SA treatment.

Behavioral health, substance abuse/treatment care setting strongly preferred.

Master’s degree in Social Work or a related field required for all departments. For Hospice, Master’s degree in Social Work required, and licensure as LCSW or LMSW is preferred.

Two (2) years of social work experience in an acute‑care setting preferred.

Heart Saver First Aid/CPR or Basic Life Support (BLS) certification required per department. Valid AZ fingerprint clearance card may be required per department.

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