Adult Home Social Worker

Overview

• Provide comprehensive case management services for assisted living patients, ensuring optimal care and support tailored to individual needs.
• Collaborate with healthcare providers, families, and community resources to enhance patient outcomes and well-being.
• Work in a hybrid setting with flexibility between remote and on-site responsibilities.
• Travel between facilities as required, with reimbursement for travel expenses.
• Engage in performance improvement strategies based on patient and program outcomes.
• Ensure timely and thorough documentation in patient charts to maintain accurate records.
• Implement interventions to assist patients in achieving personal health-related goals.
• Participate in transition of care programs, focusing on post-hospitalization follow-ups.

Key Responsibilities & Duties

• Facilitate communication between patients, healthcare providers, and community resources for coordinated care.
• Conduct outreach, education, counseling, and self-management support for assisted living patients.
• Coordinate benefits and identify resources to support patient health goals.
• Engage in hospital discharge planning and transition of care programs.
• Implement performance improvement strategies and identify patterns for health optimization.
• Ensure all activities are patient-focused and individualized for personalized care.
• Collaborate with residences and adult homes, conducting monthly visits as required.
• Maintain accurate and timely documentation in patient records.

Job Requirements

• Master of Social Work (MSW), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) certification required.
• Minimum of 1 year of case management experience in any setting.
• Excellent communication, written, and analytical skills essential.
• Proficiency in computer applications and documentation systems.
• Ability to travel between facilities with reimbursement for expenses.
• Flexibility to work remotely and on-site as required by scheduling.
• Strong organizational skills to manage multiple responsibilities effectively.
• Commitment to patient-focused and individualized care approaches.