Social Worker
Position Summary
The Social Worker provides comprehensive psychosocial services to residents, patients, and their families to promote emotional well-being, quality of life, and safe transitions of care. This position conducts psychosocial assessments, develops and implements individualized care plans, coordinates community resources, advocates for residents, and collaborates with the interdisciplinary healthcare team to ensure compliance with federal and state regulations governing long-term care.
Essential Duties and Responsibilities
- Conduct comprehensive psychosocial assessments upon admission and at required intervals, documenting findings accurately in the medical record.
- Develop, implement, and monitor individualized social services care plans in collaboration with the interdisciplinary team.
- Participate in Minimum Data Set (MDS) assessments, interdisciplinary care planning, and resident progress documentation.
- Coordinate and facilitate resident admissions, discharges, and transitions of care.
- Audit and maintain compliance with Preadmission Screening and Resident Review (PASRR) requirements.
- Assist residents and families with guardianship, power of attorney (POA), advance directives, and related legal documentation.
- Ensure Physician Orders for Life-Sustaining Treatment (POLST) forms are completed accurately and maintained in accordance with regulatory requirements.
- Advocate for resident rights, dignity, autonomy, and quality of life while promoting person-centered care.
- Participate in interdisciplinary team (IDT) meetings and resident care conferences.
- Investigate and report allegations or concerns involving abuse, neglect, self-neglect, exploitation, or resident isolation in accordance with facility policy and regulatory requirements.
- Provide education and support to residents, families, and staff regarding psychosocial needs, behavioral health, resident rights, and available community resources.
- Support community outreach initiatives, educational programs, and facility marketing activities as assigned.
- Maintain timely, accurate, and confidential documentation in accordance with facility policy, Medicare requirements, and federal and state regulations.
- Ensure compliance with all applicable federal, state, accreditation, and organizational policies and standards.
Qualifications
Education
- Master’s degree in social work (MSW).
Licensure
- Current Nevada Social Worker license in good standing, as required by state law.
Experience
- Minimum of two (2) years of experience in a Skilled Nursing Facility (SNF), Long-Term Care (LTC), or comparable healthcare setting.
Knowledge, Skills, and Abilities
- Thorough knowledge of psychosocial assessment, care planning, and discharge planning principles.
- Strong understanding of federal and state regulations governing Skilled Nursing Facilities and Long-Term Care.
- Excellent communication, interpersonal, counseling, and active listening skills.
- Ability to collaborate effectively with interdisciplinary teams, residents, families, physicians, and community agencies.
- Ability to manage multiple priorities while maintaining organization and attention to detail.
- Strong documentation and computer skills, including proficiency with electronic medical records (EMRs).
- Commitment to maintaining resident confidentiality and compliance with HIPAA and the Patient Bill of Rights.
- Ability to exercise sound judgment, maintain professionalism, and handle sensitive situations with discretion and compassion.
Physical Requirements
- Ability to sit, stand, walk, bend, reach, and move throughout the facility for extended periods.
- Ability to occasionally lift and carry up to 25 pounds.
- Ability to travel locally as needed for community outreach or professional responsibilities.
- Ability to meet occupational health and respiratory protection requirements, including respirator fit testing when required.
Working Conditions
Work is performed in a healthcare environment with frequent interaction with residents, patients, families, physicians, staff, and community agencies. The position may involve exposure to emotionally challenging situations requiring sound judgment, professionalism, and effective crisis intervention skills.
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