Social Worker - Full Time Days - Immanuel Pathways Southwest Iowa
Company: Immanuel
Location: Council Bluffs
Posted on: June 21, 2022
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Job Description:
Overview Immanuel Pathways in Council Bluffs, IA is seeking a
Full Time Social Worker. Immanuels Outstanding Benefits Package
Includes: Medical, dental, and vision PTO - accruing from day one
of employment 2 Floating Holidays per year 401K with matching
Education program - up to $5,250 per year for continuing education
Flexible schedule Plus many more benefits Responsibilities: Plans,
organizes and implements social services to Immanuel Pathways
participants and families. Responsibilities include but are not
limited to: assessment, treatment, teaching and counseling to
participant, caregiver or other appropriate representatives. Social
work interventions could include individual participant contacts;
appropriate collateral contacts; participant and family education;
assessment and counseling; provision of resources; ongoing case
management; advocacy to ensure participant and caregiver needs are
met and addressed; and disenrollment procedures. The Social Worker
is the liaison between the Interdisciplinary Team (IDT), caregiver
representatives, and community agencies. Supports and lives out
Immanuel's Mission and CHRIST Promises. Responsibilities
Requirements of Job: Be legally authorized (currently licensed or
if applicable, certified or registered) to practice the job's
functions and actions in the respective state in which he/she is
employed. Only act within the scope of his/her authority to
practice in the respective state in which he/she is employed. Agree
to abide by the philosophy, practices, and protocols of the PACE
organization. Job specific competencies for the Social Worker will
be met prior to assuming participant care. Incumbent may be asked
to cover for a counterpart at a different PACE Pathways site (only
in the state in which he/she is authorized to practice social work)
to assess potential or current participants only. KEY
RESPONSIBILITIES Key Areas Key Responsibilities and Duties of the
Job 55% Participant Assistance within the Center Performs initial
in-person assessments for enrollment of potential Immanuel Pathways
participants to obtain a complete psychosocial history, which may
include descriptions of cognitive status, social supports, family
dynamics, mental health and substance dependency, and other issues
and needs. Conducts in-person reassessment of enrolled participants
every six (6) months and as needed. Functions as a member of the
Interdisciplinary Team. Coordinates with the team to develop an
initial comprehensive plan of care for each participant. Maintains
regular attendance at, and participates in team meetings;
communicates participant changes, collaborates on plan of care
decisions and coordination for twenty-four (24) hour care delivery.
Presents requests to Interdisciplinary Team for and coordinates
admission/discharge to contracted facilities for temporary respites
and permanent placement. Presents the written participant rights
documentation to assigned participants and or caregiver on an
annual basis. In the event the participant is unable to understand
the information, ensures the caregiver or representative
understands the participant rights. If there is a language barrier
the Social Worker will provide the appropriate interpreter.
Provides ongoing support, counsel, and education to participants
and family regarding a variety of issues, including but not limited
to: the aging process, dementia, grief and loss, end of life,
disease processes, difficult family dynamics and changing roles,
PACE model and PACE health services. May be required to perform
home visits based upon an individuals Plan of Care in regards to
state applicable Home Health standards and Regulations. Acts as
facilitator for meetings with participant, family, caregivers, and
community agencies to clarify, or problem solves issues regarding
the plan of care. Mediates discussions between all parties. Acts as
liaison with participant and caregivers regarding orientation to,
and ongoing relations with Interdisciplinary Team, Participant
Center staff, and other Immanuel Pathways staff, including
volunteers. Attends and actively participates in a variety of
organizational meetings related to participant care, including but
not limited to: Morning Meeting, Intake and Assessment Meeting,
various in-services and community agency meetings. Assists
participants and caregivers in filing grievances. Assists
participants and family in coordination with Enrollment Coordinator
to keep resources within guidelines for Medicaid eligibility.
Completes and ensures completion of documentation of clinical
service, in participant's medical records including initial
assessments, reassessments, change of status, temporary or
permanent placements; hospital admissions and discharges, home and
nursing home visits and other significant events according to
Immanuel Pathways documentation requirements. Works to maintain
participant housing through intervention with participant,
caregivers and housing. Will proactively work to partner with
participant and/or caregivers to maintain appropriate housing and
assist participant to function at most independent community level
possible. 30% Participant Assistance with Outside Agencies Provides
referrals to and assessment with contracted Room and Board and
Assisted Living residences. This may involve completing
applications, obtaining medical records, accompanying participants
to interview assessments and tours if participant has no other
support systems. Performs visits within twenty-four (24) hours of
hospital admissions or on Monday if participant is admitted on a
Friday or weekend. Coordinates hospital discharges in conjunction
with Interdisciplinary Team and attending physician. Communicates
with family or caregivers frequently and as needed for updates.
Facilitates hospice or nursing home placement as needed or
requested. Initiate referrals to external resources with community
agencies such as Adult Protective Services, Housing Authority, or
public utility companies. Advocates with these entities for
purposes of maintaining community stability. Assists participants
and caregivers to complete Medical Durable Power Of Attorney
(MDPOA) Proxy, and Do Not Resuscitate (DNR) directives as needed.
Assists participants with Social Security Income (SSI) Social
Security Disability Income (SSDI) application process as needed.
Assists participants and caregivers to set up and maintain Personal
Needs Accounts. In the event of termination of the PACE
organization, the Social Worker will act to coordinate the
transitional care necessary to ensure continuation of care during
and after termination. Assists participants in obtaining
reinstatement of conventional Medicare, and Medicaid benefits,
transition participants care to other providers, make all
appropriate referrals make the participants medical records
available to new providers with appropriate participant approvals.
10% Compliance Acts within the scope of his or her authority to
practice Implements Exposure Control Plan Complies with Emergency
Preparedness Plan Uses proper lifting and push/pull techniques, use
gate belt assistance and participant transfers Protects privacy and
maintains confidentiality of all company procedures, results and
information about employees, participants and families.
Participates in and supports Quality Improvement Initiatives.
Completes internal or external ISIS PACE Reviewer training.
Completes Security Review process for system access in the
respective state in which he/she is employed. Maintains up to date
knowledge of system\process and communicates to IDT as applicable.
Complies with NE Home Health Licensure regulations for home care.
5% Other Acts as a resource to other team members and participant
center staff regarding topics such as dementia, difficult
behaviors, and difficult personalities. Participates in continuing
education classes and any required staff and training meetings.
Maintains professional affiliations and any required
certifications. Performs other duties as required or requested.
Qualifications Education- Masters Degree from an accredited school
of social work required. Experience- Two (2) years of experience
working on a multidisciplinary team in a hospital, nursing home or
community-based setting is preferred. One (1) year of experience
working with the frail or elderly population required, or
completion of job specific training related to working with the
elderly population must be completed within the first six months of
hire. One (1) year of leadership or management experience,
preferably in a geriatric care setting required. Other
Requirements- Must have medical clearance for communicable diseases
and up-to-date immunizations before having direct participant
contact. Must have a valid driver's license, proof of insurance and
have means of transportation. Basic Life Support (BLS) Skills i.e.
Health Care Level Cardiopulmonary resuscitation (CPR); Automated
External Defibrillator (AED); First Aide (FA). KSA- Knowledge
Skills and Abilities- Knowledge of psychology in analysis,
intervention and counseling with individuals or in small group
conferences. Skilled in counseling techniques, mentoring and
coaching, and/or training methods Skilled verbal and written
communication, including speaking to groups of people. Ability to
work with frail/chronically ill elderly people. Ability to provide
psychosocial assessment and individual, family and group
counseling. Ability to maintain accurate records and to prepare
clear and concise reports, correspondence and other written
materials. Ability to communicate clearly and effectively. Ability
to chart via Electronic Health Records Proven experience and basic
computer proficiency (internet, email, Microsoft Office)
Keywords: Immanuel, Council Bluffs , Social Worker - Full Time Days - Immanuel Pathways Southwest Iowa, Healthcare , Council Bluffs, Iowa
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