The Clinical Social Worker functions as a multidisciplinary team
member who provides direct clinical services and interventions to
patients, families and significant others from newborn through the
end of life. The social worker assists patients and families with
disabilities, adjustment to illness, personal, financial and
environmental difficulties which may predispose illness and
interfere with obtaining an optimal level of medical care and
quality of life. They provide comfort, support, emotional
counseling, short-term triage, and crisis intervention to patients
and their families. When needed, assists in identifying patients
who will require discharge planning services. Provides consultation
to staff and coordinates with community-based providers as required
and ensures referrals to post-hospital care and services.
Master's Degree in Social Work from an accredited school of
Social Work or equivalent.
Documentation of ongoing continuous education specific to Social
Work and Palliative Care.
Licensure / Certification
Licensed Masters Social Worker in the State of Michigan
Special Skill / Aptitudes
Must possess high level of analytical ability necessary to
identify and plan for the resolution of difficult psychosocial
illness related problems
Must possess a high level of interpersonal skills necessary to
provide counseling to patients and their families on psychosocial
illness and related problems.
Must possess leadership and group work ability necessary to
function in a shared governance department structure.
Must have good knowledge of the principles and practices of
social work. Will be expected to utilize a variety of highly
developed skills in individual and/or group methods.
Demonstrated skill in patient assessment pertinent to the age
group(s) served. Knowledge of community
resources, and skill in managing referrals. Demonstrate ability
to practice social work within a team environment.
Possess an advanced knowledge of the impact of illness on to
patient and family as well as an understanding of age specific
needs and cultural differences.
Excellent customer service orientation skills necessary in order
to deal effectively with various levels of hospital personnel,
outside customers and community groups.
2 Years of Clinical Experience
Work requires some knowledge of health care, community
resources, illness and disease, and medical terminology associated
with the services on the patient care unit(s).
Duties / Responsibilities:
1 Collaborates with the multidisciplinary team by providing a
comprehensive clinical , social assessment in order to develop and
implement the most appropriate plan of care of the newborn through
the end of life.
2 Assesses, directs and provides referral information to
patients and their families to community agencies/facilities for
short and long term assistance. In addition, maintains a strong and
ongoing working relationship with these agencies.
3 Implements discharge plans on complex discharges based upon a
thorough needs assessment in collaboration with the Patient
Logistics Practitioner (PLP).
4 Coordination of durable medical equipment (DME) for complex
5 Provides and documents in the electronic medical record
consultative clinical / social services delivered to each patient.
Ensures documentation of assessment, plan of care and follow up are
accurately completed and demonstrate ongoing support to the care of
the patient during their hospital admission thru discharge
6 Assumes responsibility for welfare of patients through the
initiation of child abuse referrals, adult protective services
referrals, nursing home abuse, domestic violence referrals and
guardianship petitions. Performs the assessment, initiates
referrals and appears in court as subpoenaed by the system.
7 Works collaboratively with other members of the health care
team, including medical staff, patient logistic practitioners, pain
and palliative care members, Hospice and other community agencies
to provide support and ongoing planning for psychosocial aspects of
care throughout the stay and discharge transitions.
8 Develops and conducts educational in-services related to a
patients psychosocial care and/or illness, as well as well as
informing healthcare care team members of current community
resources that are available to patients.
9 Formulates discharge plans by collaborating with the
patient/family, members of the healthcare team (i.e PLP[Patient
Logistics Practitioner], medical staff, nursing staff, other) and
outside agencies/facilities. Develops and coordinates discharge
plans for complex cases such as patients with difficult family
dynamics, patients facing end of life issues, placements to
extended care facility (ECF), acute long term care facility,
dialysis, arranging home healthcare and DME.
10 Assessing financial status to determine eligibility
Demonstrates and actively promotes an understanding and
commitment to the mission of St. Joseph Mercy Oakland through
performing behaviors consistent with the Trinity Health Values.
Maintains a working knowledge of applicable Federal, State, and
Local laws and regulations, the Trinity
Health Organizational Integrity Program, including the Standards
of Conduct, Code of Ethics, as well as other policies and
procedures in order to ensure adherence in a manner that reflects
honest, ethical and professional behaviors.
Supports and conducts one's self in a manner consistent with
customer service expectations.
In accordance with unit or departmental practice, determines
that appropriate charges have been entered for the correct patient,
encounter, date/time of service, with any required modifiers. Make
corrections as needed per charge capture policy/practice.
In accordance with unit or departmental practice, actively
participates in on-going education and communication regarding
In accordance with unit or departmental practice, assists with
tracking and monitoring of equipment assigned to the unit. Requests
services for maintaining equipment as needed.
In accordance with unit or departmental practice, proficient
with the electronic health records for documentation, assessment,
and care management, performing these activities concurrently with
provision of care throughout the shift.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of
hospitals and hundreds of health centers in 22 states. Because we
serve diverse populations, our colleagues are trained to recognize
the cultural beliefs, values, traditions, language preferences, and
health practices of the communities that we serve and to apply that
knowledge to produce positive health outcomes. We also recognize
that each of us has a different way of thinking and perceiving our
world and that these differences often lead to innovative
Trinity Health's dedication to diversity includes a unified
workforce (through training and education, recruitment, retention
and development), commitment and accountability, communication,
community partnerships, and supplier diversity.