Provides direct patient/family intervention for the identification and delivery of services for the patient as he/she functions within the community after discharge. In addition to direct patient care, the staff participates in a variety of hospital and community activities that enhance the process of discharge planning. Provides counseling and services as needed for neonate through geriatric aged patients and families.

ACCOUNTABILITIES

 *All duties listed below are essential unless noted otherwise*

1. Task Executor Essential Functions:

a. Interviews patients and family members to obtain information about home environment, family, relationships, health history and patient’s personality and explains patient’s background, psycho-social functioning and needs to medical staff and others in participation with planning of a comprehensive care program for patients.

b. Evaluates data gathered in terms of the medical plan of treatment, available social service programs, and plans a pertinent program that will provide each patient with maximum benefit, considering age of patient.

c. Assist patients and families to understand, accept, and follow medical recommendations in terminology they will understand.

d. Regularly works with difficult and complex cases in coordination with the medical team for the purpose case management, discharge planning, and emotional and financial adjustment to illness services.

e. Demonstrates competence, awareness, and sensitivity to the physical, emotional, and psycho-social needs of neonates through geriatric aged patients.

f. Communicates family issues to other staff members involved in the patients’ care.

 g. Participates in planning conferences, as needed. Coordinates discharge rounds, weekly.

h. Collaborates with other hospital programs and community agencies with which patients of various ages and families are involved.

 i. Prepares and maintains required documentation on each case.

j. Maintains established departmental policies, procedures, objectives, and safety standards. k. May guide activities of part-time, student, or other social workers in their management of specific cases. l. Provide for patient safety in environment and in communication with patients and families. m. Performs any other job-related duties as assigned.

2. Process Improver Essential Functions:

a. Participates in the departmental and institutional goals and objectives relative to quality improvement.

b. Serves on quality improvement teams as requested.

 3. Customer Service Ambassador Essential Functions:

 a. Works collaboratively with all levels and business units of LHA.

b. Serves as a role model for consistent demonstration of and advocacy for LHA’s Guiding Principles.

 c. Demonstrates knowledge and respects patient, service provider, and organizational confidentiality procedures and protocols.

 d. Maintains and protects patient’s rights.

e. Represents the system and its entities in fostering positive relationships with other health agencies, organizations, and community groups.

4. Personal Developer Essential Functions:

a. Maintains and improves professional and personal learning and development though literature, seminars, workshops, and affiliations.

b. Seeks and accepts education to learn new skill competencies, and maintain current competencies through educational programs, in-services, and meetings.

Provides direct patient/family intervention for the identification and delivery of services for the patient as he/she functions within the community after discharge. In addition to direct patient care, the staff participates in a variety of hospital and community activities that enhance the process of discharge planning. Provides counseling and services as needed for neonate through geriatric aged patients and families.

ACCOUNTABILITIES

 *All duties listed below are essential unless noted otherwise*

1. Task Executor Essential Functions:

a. Interviews patients and family members to obtain information about home environment, family, relationships, health history and patient’s personality and explains patient’s background, psycho-social functioning and needs to medical staff and others in participation with planning of a comprehensive care program for patients.

b. Evaluates data gathered in terms of the medical plan of treatment, available social service programs, and plans a pertinent program that will provide each patient with maximum benefit, considering age of patient.

c. Assist patients and families to understand, accept, and follow medical recommendations in terminology they will understand.

d. Regularly works with difficult and complex cases in coordination with the medical team for the purpose case management, discharge planning, and emotional and financial adjustment to illness services.

e. Demonstrates competence, awareness, and sensitivity to the physical, emotional, and psycho-social needs of neonates through geriatric aged patients.

f. Communicates family issues to other staff members involved in the patients’ care.

 g. Participates in planning conferences, as needed. Coordinates discharge rounds, weekly.

h. Collaborates with other hospital programs and community agencies with which patients of various ages and families are involved.

 i. Prepares and maintains required documentation on each case.

j. Maintains established departmental policies, procedures, objectives, and safety standards. k. May guide activities of part-time, student, or other social workers in their management of specific cases. l. Provide for patient safety in environment and in communication with patients and families. m. Performs any other job-related duties as assigned.

2. Process Improver Essential Functions:

a. Participates in the departmental and institutional goals and objectives relative to quality improvement.

b. Serves on quality improvement teams as requested.

 3. Customer Service Ambassador Essential Functions:

 a. Works collaboratively with all levels and business units of LHA.

b. Serves as a role model for consistent demonstration of and advocacy for LHA’s Guiding Principles.

 c. Demonstrates knowledge and respects patient, service provider, and organizational confidentiality procedures and protocols.

 d. Maintains and protects patient’s rights.

e. Represents the system and its entities in fostering positive relationships with other health agencies, organizations, and community groups.

4. Personal Developer Essential Functions:

a. Maintains and improves professional and personal learning and development though literature, seminars, workshops, and affiliations.

b. Seeks and accepts education to learn new skill competencies, and maintain current competencies through educational programs, in-services, and meetings.