Medical Social Worker Per Visit

Alpine Care Home Health is dedicated to providing expert, compassionate care in the home setting. Our team of skilled clinicians help individuals remain safe and independent in their homes, with personalized care that respects the individuals’ goals, values, and overall well-being.

Our team brings deep expertise in physical therapy, occupational therapy, speech therapy, wound care, and complex care management, and more. We offer customized tools and hands-on support to improve mobility, accelerate recovery, and encourage lasting self-reliance.

We take pride in offering personalized, evidence-based care. We work closely with primary care providers, families, and specialists to create care plans that are proactive, holistic, and aligned with each patient’s priorities.

Through access to a full range of physical and mental health services, we aim to support patient independence and long-term stability.

We’re building a purpose-driven team passionate about making a difference. If you’re excited to shape the future of home-based care, here’s what the role involves.

Position Overview

The Medical Social Worker Per Visit (MSW) is a qualified professional who, in accordance with the plan of treatment, assists the physician and other team members in understanding the significant social and emotional factors related to the health problems. The MSW PRN also participates in the development of the plan of treatment, prepares clinical and progress notes, works with the family, utilizes appropriate community resources, participates in discharge planning and in-service programs and acts as a consultant to other agency personnel.

Essential Duties and Responsibilities

Provide medical social work services where appropriate, to individuals and families receiving skilled services from the Agency

Resolve social or emotional problems that are or are expected to be an impediment to the effective treatment of the patient's medical condition or rate of recovery

Develop and implement a plan of care that necessitates the skills of a qualified medical social worker to be performed safely and effectively

Assess the relationship of the patient's medical and nursing requirements to the patient's home situation, financial resources and availability of community resources

• Take appropriate action to obtain available community resources to assist in resolving the patient's problem
• Provide counseling services that are required by the patient

Provide medical social services to the patient's family member or caregiver on a short-term basis (i. e. 2-3 visits) when the HHA can demonstrate that a brief intervention by a medical social worker is necessary to remove a clear and direct impediment to the effective treatment of the patient's medical condition

Complete evaluation paperwork and patient care plan submitted to Clinical Supervisor per agency policy and procedure

Provide medical social services including assessment, evaluation, procedures, teaching and training activities as outlined in the patient Plan of Care

• Submit completed visit notes, communication notes per agency policy and procedure
• Submit change orders per agency policy
• Maintain open lines of communication to all members of the continuum of care team
• Act as a preceptor in the orientation of new medical social work staff as requested
• Attend staff meetings, team conferences and educational in-services per agency requirements
• Participate in Process Improvement (PI) program by assisting with collection of data and serves on PI team upon request
• Participate in discharge planning process in accordance with Medicare Criteria and agency policy and procedure
• Follow agency policies and procedures
• Maintain productivity level at 90%
• Perform these and all other duties as assigned by the Administrator
• Able to lift 40 pounds from floor to shoulder
• Repetitive walking, standing, sitting, bending, and use of hand
• Able to drive a car 2-4 hours per day
• Responsible to ensure the use of the 4Ms (What Matters to the patient, Medications, Mentation, and Mobility) and provides Age-Friendly Care
• Other duties as assigned

Required Knowledge, Skills and Experience

A Master's degree (MSW) or doctoral degree from a school of social work accredited by the Council on Social Work Education

• Active CPR Certification
• Current unencumbered State professional license
• Must maintain a valid driver's license and good driving record

An Automobile to Be Used for Work

• One (1) year of social work experience in a health care setting as per §484.115(m)
• Proficiency in clinical skills
• The ability to make sound professional clinical judgment
• The ability to assess and document patient needs and formulate individualized patient care plans to meet those needs

Excellent Verbal and Written Communication

Proficiency in personal computer use including email, clinical, word processing, and spreadsheet software

Perks and Benefits (What We Offer)

• Competitive salary and multiple health benefit options
• Career growth and development
• Mentorship and continued learning opportunities
• Engaging and mission driven workplace
• 401(k) matching
• Mileage reimbursement (if eligible)

Every person on our team helps shape the future of Alpine Care Home Health. If you're excited by meaningful work and shared impact, we’d love to hear from you.