Description
Summary of Position:
Provides selected social service interventions and assists with discharge planning for residents in Skilled Nursing utilizing established standards and practice, ensuring safe and effective intervention. Utilizes inpatient Social Worker for assessment validation and resource for further education. Services are provided based on the ages of the population served; Newborn through geriatric - 65 years or older and in collaboration with the multidisciplinary care team.
Assesses, plans, intervenes and evaluates intervention in collaboration with the multidisciplinary care team. Demonstrates the knowledge and skill necessary to identify and meet the individualized needs of all residents served in Skilled Nursing. The Resident Relations Coordinator reports to the Skilled Nursing Director.
Qualifications
Education:
● High school diploma or GED required
● Bachelor's or Master's degree in Social Services or other related field preferred
Experience:
● Previous experience as a Social Worker preferred
Knowledge/Skills/Abilities:
● Previous computer experience and data base management preferred
● Sufficient computer skills as are required to complete an online application and the pre-employment/annual Net Learning requirements
● In compliance with patient safety standards, must be able to effectively communicate in English; Bilingual abilities preferred
Certifications/Licensure:
● Social Services Designee Certification required within 6 months of hire
● Current CPR/BLS certification by the American Heart Association (BLS for the Healthcare Provider)
● Valid California or Nevada Driver's license (depending on state of employee's residence) or ability to obtain prior to start date
● DMV Printout showing clean driving record
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
● While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear.
● The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.
● The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
● Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
● The employee must occasionally lift and/or move up to 25 pounds.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
● Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.
● Occasional travel to various health system locations.
Essential Functions
1. Provides consistently exceptional care at all times.
2. Develops and implements social services that meet the physical, mental and psychosocial needs of the residents. Evaluates outcomes, consults with others as required and adjusts care plan as necessary to ensure optimal outcome.
3. Performs social service assessment and reassessments on all identified residents according to organizational timeframes. Gathers and integrates data to determine social service needs of resident. This is accomplished by weekly meeting with Interdisciplinary Team to discuss following needs of residents:
a. Psychosocial – family support, living situation, financial status.
b. Cultural & spiritual values
c. Mental Status – Orientation, Ability to self care, Coping Mechanisms
d. Determines presence of any barriers to a safe and effective transition from Skilled Nursing to a lower level of care.
4. Ensures applicable sections of MDS and CAA's are complete and accurate and accomplished according to established timeframes.
5. In collaboration with the multidisciplinary team, develops a plan based on the assessed needs of the resident.
● Ensures that care plan accurately reflect resident needs and attainment of goals.
● Collaborates with other disciplines and community agencies
● Communicates family issues and concerns to care team
6. Evaluates resident's response to therapy and writes a minimum of quarterly progress notes which reflect resident's progress towards states goals. Revises care plan based on resident response to treatment/ therapy.
7. Coordinates physician consult visits
● Dentist
● Dental hygienist
● Optomotrist
● Podiatrist
● Tele health consults
8. Effectively coordinates scheduled daily job tasks. Completes tasks independently requiring little or no direction. Is able to promote safety, respect, image and efficiency in team environment.
9. Coordinate LTC admissions
a. Visits with potential admits
b. Confirmation of pay source
c. Communication with MDS and DON
d. Request orders from MD- talk to Melinda about getting orders written
e. Email SNF team (DON, MDS, biller, Admin Coord, charge nurses, act. Director) of admission. Information to include:
i. Resident name, insurance carrier, room number, date being admitted
ii. Services being provided- i.e. skilled vs LTC
iii. Where they are coming from
iv. Who is coming to sign paperwork and answer questions
v. Accepting physician-
10. Focuses on customer service needs. Liaison between resident, family members and facility; keeping family members informed of resident needs. Keeps Charge Nurse/Director of Nursing informed of resident social services needs and admission/transfer/discharge barriers on a daily basis.
11. Assists residents with finances as necessary, ensuring accuracy of documentation.
● Yearly MediCal and social security benefits.
● Resident mail
o Sort and deliver, screen for residents that need mail forwarded to family, etc.
o Keep eyes open for mail from Social Security and Medi-Cal renewal and be sure these are opened timely.
12. As directed, supports the activities and recreational program in a manner that is safe and sensitive to the rights of each resident. Provides a comfortable, relaxed and orderly atmosphere during activities. Assists in developing new activities, stimulating and encouraging residents to explore new interests, build reliance and build independence.
13. File paperwork with Social Security and Medi-Cal-
o 2 copies of MC-171: (bottom section for deceased) one to Cynthia (Medi-Cal) and one with Social Security- On admission
o when discharged or expired
14. Personal belongings of deceased resident to family
15. Assists Activity Director with assessment and reassessments at designated and appropriate intervals on all residents, recognizing the residents individualized needs.
16. Responds to the needs of the department by performing other duties, as necessary.
17. Completion of ABN's as appropriate and re admission paperwork
18. Responsible for Theft/Loss program
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