Licensed Social Worker - FT Days in Las Cruces, New Mexico at Three Crosses Regional Hospital

In summary, the expectations of someone that joins a high reliability hospital are exceedingly high. It will require your full commitment to practice each of these norms and demonstrate that you care enough about our patients to keep them as safe as you can.

Job Summary

Under the supervision of the Manager of Case Management, the Emergency Department Social Worker provides psychosocial assessment, care coordination, discharge planning, crisis intervention, resource navigation, and transition-of-care support to patients presenting to the Emergency Department.

The Social Worker assists in meeting the psychosocial needs of patients and enabling patients to utilize medical care and community resources to achieve their optimal level of health. The Social Worker assesses patients for discharge-planning needs and assists with referrals to appropriate local, state, and community resources to facilitate safe and appropriate transitions from the Emergency Department.

The Social Worker participates in Screening, Brief Intervention, and Referral to Treatment (SBIRT) activities for patients with identified or suspected alcohol and/or substance-use concerns. Responsibilities may include screening, brief intervention utilizing motivational interviewing techniques, assessment of readiness for change, and referral or warm handoff to appropriate substance-use treatment and recovery resources.

The Social Worker collaborates with Emergency Department physicians, nursing, Case Management, behavioral health providers, patients, families, post-acute providers, and community agencies to identify and address psychosocial and social determinants of health barriers that may impact treatment, discharge, or continuity of care.

The incumbent will have knowledge of healthcare systems and demonstrate the ability to interact, relate to, work with, and support the activities of a diverse workforce and patient population.

The incumbent is expected to perform all duties while adhering to the highest standards of ethical and professional conduct, acting in the best interests of Three Crosses Regional Hospital, and fully supporting its mission, vision, and values.

Duties/Responsibilities:

• · Assumes an active care-coordination role and collaborates with the interdisciplinary Emergency Department team to identify and address psychosocial, behavioral, social, and discharge needs that may impact the patient’s treatment or disposition.

  · Performs psychosocial assessments and evaluates patient needs, including medical, psychological, behavioral, social, financial, environmental, caregiver, and community-resource factors.

  · Assesses patients for social determinants of health and other barriers that may interfere with a safe discharge or successful follow-up, including housing instability, homelessness, food insecurity, transportation limitations, medication access, financial barriers, caregiver limitations, and access to healthcare services.

  · Initiates discharge planning from the Emergency Department and assists in developing safe, appropriate, and patient-centered discharge plans in collaboration with the patient, family/caregiver, physician, nursing, Case Management, and other members of the interdisciplinary team.

  · Assesses patients’ post-discharge needs and facilitates referrals and services necessary to address identified needs and promote continuity of care.

  · Coordinates appropriate community and post-acute services, which may include home health, durable medical equipment, skilled nursing, rehabilitation, behavioral health, substance-use treatment, transportation, shelters, food resources, financial assistance, medication-access resources, and other community-based services.

  · Facilitates transitions to the appropriate level of care or community setting based upon the patient’s identified needs and the treatment/discharge plan.

  · Works collaboratively with the ED Case Manager, provider, nursing, and interdisciplinary team to identify and address barriers contributing to delays in discharge, repeat Emergency Department utilization, or potentially avoidable hospitalization when patient needs can be safely met in an appropriate alternative setting.

  · Provides patients and families with education, resources, referrals, and contact information necessary to support the discharge and transition-of-care plan.

• · Supports Screening, Brief Intervention, and Referral to Treatment (SBIRT) processes for patients with identified or suspected alcohol and/or substance-use concerns in accordance with organizational policies and procedures.

  · Completes or supports appropriate alcohol and substance-use screening utilizing hospital-approved screening tools and established workflows.

  · Provides brief intervention using patient-centered communication and motivational interviewing techniques when indicated.

  · Assesses patient readiness for change and assists patients in identifying appropriate treatment, recovery, harm-reduction, and community resources consistent with the patient’s needs and organizational policies.

  · Facilitates referral and, whenever feasible, a warm handoff to appropriate substance-use treatment and recovery resources, including outpatient treatment, residential treatment, detoxification services, behavioral health services, peer-support programs, and community recovery resources.

  · Provides crisis intervention and supportive counseling within the scope of the Social Work position for patients and families experiencing acute illness, trauma, grief, loss, behavioral health concerns, substance-use concerns, or significant psychosocial stressors.

  · Assists with patients experiencing homelessness, housing instability, suspected abuse or neglect, interpersonal violence, exploitation, substance-use disorders, and other high-risk or vulnerable circumstances.

  · Follows applicable mandatory-reporting requirements and organizational policies related to suspected abuse, neglect, exploitation, or other reportable concerns.

  · Collaborates with appropriate community agencies, which may include Adult Protective Services, Child Protective Services, behavioral health providers, substance-use treatment programs, shelters, law enforcement, and other community organizations as appropriate.

  · Maintains current knowledge of available local, state, and community resources and assists patients and families in navigating eligibility requirements and accessing appropriate services.

  · Develops and maintains collaborative working relationships with community agencies, behavioral health providers, substance-use treatment and recovery programs, shelters, transportation resources, post-acute providers, and other organizations supporting patients following Emergency Department discharge.

  · Identifies high-risk and high-utilization patients and assists with individualized resource coordination and connection to appropriate outpatient and community-based services.

  · Advocates for patient needs and promotes patient and family participation in care and discharge planning.

  · Ensures care coordination and discharge-planning activities support safe, appropriate, and cost-effective care without compromising patient safety or outcomes.

  · Documents psychosocial assessments, discharge-planning activities, SBIRT interventions, referrals, resources provided, patient/family communication, barriers, and outcomes accurately and timely in the electronic medical record.

  · Maintains patient confidentiality and complies with HIPAA, hospital policies, professional standards, and applicable federal and state requirements.

  · Participates in departmental and organizational performance-improvement activities related to ED throughput, discharge planning, transitions of care, social determinants of health, SBIRT, community-resource utilization, and avoidable Emergency Department utilization as assigned.

  · Attends staff meetings and interdisciplinary meetings as needed.

  · Performs other duties as assigned.

  Knowledge, Skills and Abilities

  · Demonstrates critical-thinking, time-management, assessment, and problem-solving skills.

  · Knowledge of care coordination, discharge planning, transitions of care, and community-resource navigation.

  · Knowledge of psychosocial assessment and social determinants of health.

  · Knowledge of SBIRT principles, brief intervention, motivational interviewing, and substance-use treatment and recovery resources.

  · Knowledge of behavioral health and crisis-intervention principles appropriate to the scope of the position.

  · Ability to work effectively in a fast-paced Emergency Department environment and prioritize multiple patient needs.

  · Excellent verbal and written communication, including timely and accurate documentation.

  · Excellent relationship management with patients, families, physicians, nursing, care providers, community agencies, and interdisciplinary team members.

  · Ability to organize and prioritize tasks.

  · Demonstrates patient-centered, culturally responsive, trauma-informed, and professional communication.

  · Ability to maintain appropriate professional boundaries and patient confidentiality.

Education and Experience

• Required: Bachelor’s degree Social Work (BSW)
• Preferred: Master’s degree in Social Work (MSW)
• Preferred: 2 years’ experience in an acute healthcare setting or case management experience
• Preferred: Experience with electronic and case management documentation systems; willing to train
• Required: Pass Fit Test
• Required: Meet all Employee Health Requirement

License/Certification(s)

• Required: Current licensure as a LBSW Social Worker (bachelor level), LMSW Social Worker (master level), or LISW (Licensed Independent Social Worker) from the New Mexico Board of Social Work Examiners.
• Required: BLS certification

“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law”.