GENERAL SUMMARY: The Women's and Children's Social Worker serves as a dedicated resource and bridge for psychosocial support across the NICU, PICU, Pediatric Unit, Labor and Delivery, and Postpartum units. This role improves communication between clinical staff and families, ensures adherence to national standards, and manages complex psychosocial needs. Coordinates clinical patient services and provides efficient resource utilization to assure optimal clinical quality outcomes by assessing, planning, and implementing patient care plans, including family psychosocial and discharge planning needs. Serves as a liaison with community resources. Participates in quality assessment and continuous quality improvement activities. Complies with all appropriate safety and infection control standards. Performs all job duties and responsibilities in a courteous and customer focused manner according to the Hurley Family Standards of Behavior.

SUPERVISION RECEIVED: Works under the general direction of a departmental director, departmental supervisor, or designee who reviews work primarily through conferences and reports. Position requires a self-directed approach to performing responsibilities and duties.

SUPERVISION EXERCISED: May supervise other professional work staff, such as master and bachelor social work interns and volunteer staff.

MINIMUM ENTRANCE REQUIREMENTS:

• Master's degree in Social Work from a college or university accredited by the Council on Social Work Education (CSWE).
• One (1) year of post graduate experience as a social worker.- Two full semesters of Social Work Case Management internship work with Hurley Medical Center would substitute for one (1) year of post graduate experience. - Prior relevant Social Work experience may be considered.
• One (1) year of post graduate experience as a social worker in an acute care facility preferred. Strong Preference for Pediatric/Neonatal/Obstetrical experience.
• Current knowledge of governing regulations, third party payor utilization, quality mandates, reimbursement requirements and standards associated with medical case management.
• Ability to work independently, set priorities and organize work while maintaining flexibility.
• Ability to effectively function under pressure and during stressful situations.
• Ability to compile, analyze, and evaluate data and prepare accurate reports from such data.
• Ability to effectively communicate in both oral and written modes.
• Ability to walk from unit to unit.
• Ability to establish and maintain effective, harmonious working relationships with patients and their families, physicians and staff, external agencies and the public.

NECESSARY SPECIAL REQUIREMENT:

• Licensed as a Social Worker through the State of Michigan.

Core Training & Certification Requirements:

• The successful candidate will be expected to achieve proficiency in:
• Clinical Standards: Proficiency in American Academy of Pediatrics (AAP), AWHONN and ACOG standards for discharge planning and social work in acute pediatric and obstetric settings.
• Legal & Ethical Guidelines: Mastery of HIPAA-compliant chart access, including training on the limitations of accessing maternal records for pediatric patients and vice-versa.
• Specialized Systems: Advanced EPIC documentation training, particularly regarding MDPOA, CPS status, and foster care coordination, surrogacy, and adoption protocols.
• Institutional Policies: Comprehensive knowledge of Safe Delivery protocols and Mandatory Reporting procedures.

RESPONSIBILITIES AND DUTIES:

1. Identifies patients for case management through screening mechanisms who are at risk for lengthy inpatient days, complex physiologic needs, or repeat admissions due to chronic illness.
2. Assesses patient and family psychosocial and environmental needs, including coping mechanisms assessing effectiveness on compliance with plan of care and desired outcomes.
3. Makes referrals to appropriate health team members or community agencies to provide assistance as necessary. Works collaboratively with physicians and others to achieve desired outcomes.
4. Identifies potential or actual patient/family issues which require referrals for financial counseling, legal representation, and risk management.
5. Assists patient/family and other health care members to identify potential ethical issues and propose resolutions. Assures informed choice options are communicated to patient/family.
6. Maintains current understanding of payer/reimbursement practices and regulations which may impact patient's plan of care.
7. Maintains awareness of available community resources including home health agencies, nursing homes, and other alternative care providers. Provides options to patients and families as necessary.
8. Facilitates discharge planning process and works collaboratively with Nurse Case Manager and others to coordinate and set up required services for post hospitalization needs.
9. Identifies psychosocial learning needs of patients and families in conjunction with other health care team members. Facilitates development of teaching plans to positively affect patient outcomes.
10. Collaborates regularly with Nurse Case Managers and others to facilitate the interdisciplinary care of patients.
11. Identifies operational bottlenecks and issues, which impact efficient delivery of care. Assists in development of plans to improve or resolve issues.
12. Identifies process improvement opportunities and collaborates with development of quality improvement plans and promotes resolution.
13. Demonstrates self-directed commitment to professional growth.
14. Serves as role model demonstrating high level of knowledge regarding case management, continuum of care services, resource utilization, assisting with staff learning needs.
15. Provides counseling/support to patients/families to assist with resolution of psychosocial reactions to illness, crisis and hospitalization.
16. Demonstrates effective judgment and ability to understand, react effectively and treat (if appropriate) unique needs of patient age groups served.
17. Performs other related duties as required. Utilizes new improvements and/or technology that relate to job assignment.

Key Responsibilities:

• Complete psychosocial assessments for infants and families admitted to the NICU, Peds, PICU and the Mother Baby Complex. Identify and address social determinants of health that may impact the patient’s outcome through advocacy of the psychosocial needs of patients and their families. Promoting family engagement in patient care to encourage developmentally appropriate bonding.
• Huddles & Rounds: Actively participate in daily morning huddles and multidisciplinary rounds across all assigned units to ensure integrated care. As well as facilitate or participate in family meetings to enhance communication between families and the healthcare team.
• Discharge Planning: Collaborate closely with in-house Nurse Case Managers on discharge planning, providing support as assigned or stepping in to cover these tasks when the Case Manager is off or unavailable.
  • Collaborate with physicians, nurses, case managers, therapists, lactation consultants, and other healthcare professionals to develop individualized discharge plans.
  • Coordinate referrals to community agencies and early intervention services.
  • Assist with arrangements for home health services, durable medical equipment, specialty prescriptions, specialty follow-up appointments, and transportation when appropriate.
  • Ensure families understand available community resources, financial assistance programs, insurance benefits, and public assistance services.
  • Participate in discharge readiness planning to promote safe transitions to home or other care settings.
• External Agency/CPS Coordination: Function as the primary liaison for active Child Protective Services (CPS) investigations and complaints. As well as collaboration of other agencies when safety concerns arise, following legal and organizational policies.
• Support Services: Provide direct support to patient families. Assist families in coping with grief, trauma, unexpected diagnoses, infant/child loss, bereavement and end-of-life situations. Provide emotional support and crisis intervention to parents and family members during hospitalization.
  • Assess family strengths, support systems, cultural considerations, mental health concerns, financial needs, housing stability, transportation, and barriers to care.
  • Assess for Post-partum depression and provide support/resource acquisition for patients as appropriate and per industry standards.
• Record Coordination: Facilitate the acquisition of necessary records from external facilities (e.g., treatment centers).
• Knowledge Sharing: Host quarterly "knowledge transfer" sessions for the broader hospital social work team, hospital staff, providers and any other multidisciplinary stakeholders to review specialty-specific protocols, such as meconium testing, MDPOA requirements, and labor/delivery legal mandates as requested.
  • Provide education to staff regarding family dynamics, trauma-informed care, cultural competence, and available community resources.
  • Collaborate with palliative care, ethics, behavioral health, chaplaincy, and child life specialists as needed.
• Resource Acquisition & Coordination: Proactively identify and secure essential patient resources, including programs such as CHAP (Children’s Health Access Program), Children’s Special Health Care Services (CSHCS), Early on, Nurse Family Partnership (NFP), Maternal Infant Health Program (MIHP), Medicaid, SSI, insurance issues, parental leave resources, etc. to support patient and family needs during and after their hospital stay.
• Documentation: Utilize designated electronic medical record platforms to document care provisions.
  • Document psychosocial assessments, interventions, referrals, discharge planning activities, and family interactions in the electronic medical record.
  • Maintain accurate, timely, and confidential documentation in accordance with hospital policies and regulatory standards.