Social Worker

Position Description

Employees in this classification are responsible for providing social services to patients and their families by assisting them with personal and environmental difficulties which predispose illness or interfere with obtaining maximum benefits from medical care. Persons in this position work closely with physicians and nursing staff to further their understanding of significant social and emotional factors underlying patient's health problem. They also serve as a resource referral service in advising patients and their families about available community resources.

Major/Essential Functions

• Conduct comprehensive psychosocial assessments for neurology patients
• Identify emotional, behavioral, social, and environmental needs impacting care
• Provide short-term counseling and emotional support to patients and families
• Assist patients coping with diagnoses such as stroke, epilepsy, neurodegenerative disorders, or traumatic brain injury
• Develop and implement individualized care plans in collaboration with the clinical team
• Coordinate referrals to community resources, rehabilitation services, and support programs
• Assist with transitions of care (e.g., hospital to home, outpatient to long-term care)
• Facilitate access to home health services, therapy, and durable medical equipment
• Work as the primary person in our collaborative care model