M Health Fairview is seeking a full time solid organ transplant social worker to provide assessment, treatment, interventions, and recommendations to facilitate movement through the continuum of care tokidney/pancreas transplant patients and their families. This role will also participate in and provide the social work perspective to an interdisciplinary team, as well as provide social work treatment to patients and their families throughout the transplant process (pre and post-transplant). The role is primarily in an outpatient settting at the Clinics and Surgery Center on the East Bank but some inpatient coverage will be intermittently needed.

• Plans and implements treatment and transition care plans based upon a psychosocial assessment that is integrated into an interdisciplinary care plan.
• Provides a range of social work interventions that include, case management, counseling, crisis intervention, and advocacy in assisting patients and families reach their goals. Identifies and recognizes rapidly changing situations and quickly intervenes to prevent or resolve the emotional crisis.,
• Arranges, mobilizes, utilizes, and may coordinate a comprehensive range of community resources which most effectively meet the identified patient and family needs.
• Takes leadership role in facilitation of interdisciplinary communication as it relates to patients and families experiencing complex psychosocial issues.
• Formally and informally educates patient/family and health care team members regarding the social work role, pertinent patient care issues, and population specific information.
• Serves as a preceptor or field instructor for social work graduate and undergraduate training as appropriate to their skills related to a range of psychosocial issues and interventions.
• Serves as patient advocate and liaison with physicians, families and community to ensure continuity of care.
• Documents psychosocial assessment, progress notes, care plans and discharge/transition plan in the electronic medical record.
• Identifies and participates in Quality Improvement, research and program evaluation initiatives that focus on improving health care services Demonstrates knowledge and compliance with MHealth Fairview and Social Work practice, ethics and standards.
• Complies with the legal and regulatory law including mandated reporting requirements.

Required:

• Master's degree in Social Work with medical experience
• Current Minnesota Social Work Licensure at the LGSW

Preferred:

• 3-5 years experience in a health care setting
• LICSW
• Experience with dialysis/renal care, knowledge of Medicare, other transplant experience