Our Mission is to extend the healing ministry of Christ.

We are more than healthcare. We are a family of caregivers who see what we do as a calling and treat every person, every time as if they were a loved one. We don’t just heal what hurts. We ease minds and encourage spirits by providing a more personal level of care than ever before—physically, emotionally, and spiritually. Our mission is to Extend the Healing Ministry of Christ which starts with caring for others with uncommon compassion and going above and beyond to make those we serve, feel loved.

Wellness is at the core of what we do, focusing on living a better life today and always. We want everyone to Feel Whole and we see our work as a calling. This is how we make a difference. With our whole-person care, expertise and world-class resources we strive to provide an exceptional experience for all. With hospitals and facilities in over 9 states, our consistent approach to healthcare allows us to live our mission and ensure that our communities are living fuller, healthier lives.

GENERAL SUMMARY:

As the clinic’s integrated behavioral health clinician, you are responsible for supporting the mental health needs of the clinic’s patients through real-time consults, scheduled therapy (targeted intervention and shorter term therapy) and care management. You are also responsible for supporting the team in providing whole-person care and working closely with the clinic teams.

Responsible for coordinating and implementing post-discharge plans in coordination with the Case Managers through the use of Extended Care Information Network (ECIN). They are also responsible for assisting with advocacy and referrals to other community resources.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

·    Available on-site at the clinic for consults including safety assessments, mental health consults and patients wanting to improve their overall health and well being.*

·    Educate and support clinic team members on providing whole-person care to our patients through sharing mental health resources and improving access to care.*

·    Participate in team huddles and improving clinic workflows.*

·    This position is clinic based and NOT in a hospital.*

·    Build strong relationships with community mental health partners.*

·    Obtains, reviews and analyzes information relative to discharge planning in accordance with hospital policy.*

·    Assess/reassess patient’s clinical and psychosocial status, premorbid status, community services utilized, and diagnosis and treatment plan per Case Management referral.*

·    Through assessment process identifies community resources needed and facilitates referrals to agencies (local and state) or programs for assistance as needed.*

·    Educates patient and/ or family on community resources available for assistance.*

·    Facilitates discharge planning working with patient, families and treatment team making any needed referrals/arrangements and documenting actions.*

·    Documents actions taken in progress notes and/or discharge planning-assessment form from initial visit through to D/C.*

·    Demonstrates professionalism in actions and job performance in accordance with mission and the social work code of ethics.*

·    Demonstrates and understands the needs of the following age specific categories: neonatal, pediatric, adolescent, geriatric and implements a discharge plan tailored to the age specific needs of the patient.*

·    Demonstrate special sensitivity toward different age groups, ethnic, cultural and disabling human diversity and human development.*

·    Conforms to standards of patient and family confidentiality according to hospital and NASW standards and HIPPA.*

·    Assesses patient’s physical, psychosocial, cultural and spiritual needs through observation, interview, review of records and interfacing with interdisciplinary team and caregivers to ensure appropriate referrals.*

·    Reevaluates and makes adjustments to discharge plan as patients’ condition changes.*

·    Ensures that appropriate arrangements for post-hospital care are made before discharge to avoid unnecessary delays in

·    discharge.*

·    Assesses patient/family emotional, social and financial needs and assists in setting up community resources to meet these needs.*

·    Provides support to patients and families who are having difficulty coping effectively with changing medical conditions.*

·    Confirms treatment goals and anticipated plan of care through discussions with treatment team/review of documentation.*

·    Communicates treatment goals or best practices to treatment team including physician.*

·    Uses ECIN to facilitate electronic referrals for discharge planning.*

·    Uses supportive crisis intervention including illness, grief/loss in decision making process.*

·    Consults and communicates, as appropriate, with manager regarding difficult practice issues.*

·    Adheres to state and federal regulations pertaining to discharge.*

·    Implements discharge plan in accordance with physician direction and patient/caregiver agreement.*

·    Assesses patient/family learning style and appropriately teaches and documents understanding.*

·    Collaborates with interdisciplinary team to develop and implement holistic, individualized plan of care.*

·    Works in collaboration with Case Management Coordinator, Home Care Coordinator and Utilization Review to ensure seamless and timely delivery of services.*

·    Maintains updated referral resource lists.*

·    Assess, coordinates and evaluates discharge readiness with CM and use of resources and discusses variances on an as needed basis with treatment team.*

·    Participates in Family Conferences and Interdisciplinary Team Meetings on an as needed basis with Case Manager.*

·    Reviews variance in plan of care concerning discharge planning with CM and/or CM supervisor as needed.*

·    Completes daily discharge planning verbal rounds with CM department to prioritize daily activities.*

·    Initiates discharge planning day one of referral to assist with LOS management.*

·    Works with third party payors and CM to satisfy discharge planning needs and obtain approval of post discharge plans.*

·    Implements plan and communicate possible options for d/c with regard to insurance benefits and contracted providers.*

·    Makes appropriate outside agency referrals.*

·    Follows through with all aspects of d/c planning across continuum of care.*

·    Provide supervision/preceptorship for department medical social workers pursuing advanced licensure*

·    Perform SBIRT evaluations, biopsychosocial assessments and crisis evaluations.*

KNOWLEDGE AND SKILLS REQUIRED:

·    Knowledge of clinical interventions and training therapies including CBT, ACT, solution-focused and MI are encouraged.

·    Passion for whole-person care and initiative to suggest changes to improve care for patients as needed.

·    Knowledge of community resources used for discharge planning, hospital operations, excellent communication/    presentation skills, knowledge of third party payment systems, Medicare/Medicaid programs.

·    Maintains current knowledge base of community services through continuing education.

·    Ability to multi-task, set priorities and maintain organization.

·    Computer skills

EDUCATION AND EXPERIENCE REQUIRED:

·    Master Degree (Graduate of Accredited Master’s in Social Work Program)

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

·    Current LCSW License if required by state.

LIVING OUR SERVICE STANDARDS

How we treat those we serve and each other is what sets us apart from other healthcare organizations. We want everyone who walks through our doors to feel loved, cared for, and at ease.  Whether you are clinical or non-clinical, your actions and behaviors can create an environment that either builds trust or causes anxiety and fear. We have made it easy for you to ensure that you are always building trust and providing excellent care by exhibiting our Service Standards. 

All team members will be held accountable for consistently living out our 16 Service Standards and the additional behaviors listed below to ensure that every person, every time has an exceptional experience.

KEEP ME SAFE

I make safety my number one priority.

I protect privacy and confidentiality.

I keep my environment clean.

I follow the dress code and wear my badge correctly.

LOVE ME

I treat others with uncommon compassion.

I nurture whole-person care through CREATION Health.

I treat others with fairness and respect.

I listen and communicate using iCARE. (Introduce, Connect, Anticipate, Reinforce, Extend)

MAKE IT EASY

I help guests to their destination.

I speak highly of others to provide connected care.

I collaborate to create solutions, not excuses.

I innovate and continually seek ways to improve our work.

OWN IT

I am positive and aim to exceed all expectations.

I follow through on commitments.

I use discretion with personal devices.

I recover service and restore trust using ACT. (Acknowledge/Apologize, Correct, Thank)

Team members must conform to all AdventHealth organizational and departmental policies and procedures including but not limited to:

·    Mission

·    Vision

·    Values

·    Code of Conduct as outlined in the “Guidelines for Employees” handbook

Establishes and maintains a history of regular attendance; makes appropriate use of PDO and observes department call-in procedures for absence; establishes and maintains punctual work habits. Exhibits timely arrival and departure and dependable time habits including meal and other breaks.

Attends and participates in mandatory facility-wide and department training/meetings as required (including but not limited to:  ALN, safety training, etc.). Is able to demonstrate and apply knowledge of fire, safety, security, and disaster procedure regulations as presented in orientation, outlined in the safety manual, and as pertains to each work area.

Required to respond to emergency situations (i.e. disasters, hurricanes, etc.) by reporting to department and staying until the crisis is over or your position is covered by incoming personnel. This is a mandatory requirement. Refusal to respond may result in termination.

Contributes to the successful achievement of department-stated goals and objectives and will facilitate staff cohesiveness and communication.

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About AdventHealth

At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.

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