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Social Worker MSW, FH

Cape Cod Healthcare

Hyannis, MA
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Cape Cod Healthcare
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Job Details

Cape Cod Healthcare

Department: Social Service
Schedule: Per-diem
Shift: Day Shift
Hours: Per Diem Hours, rot days, occ w/e, occ hol.
Job Details:


Cape Cod Healthcare is the leading provider of healthcare services for residents and visitors of Cape Cod.  With more than 450 physicians, 4,700 employees, and 1,100 volunteers, Cape Cod Healthcare operates two-acute care hospitals, the Cape's leading provider of homecare and hospice services (VNA), a skilled nursing and rehabilitation facility (JML Care Center), an assisted living facility (Heritage at Falmouth), the Cape's only local laboratory service (CCHC Laboratory Services) and numerous health programs.  We are currently seeking a dedicated Social Worker to join our team at Falmouth Hospital.


Cape Cod Healthcare offers competitive salaries, excellent benefits packages, tuition reimbursement, and generous paid time off.



Provides discharge planning and counseling services to Falmouth Hospital patients and their families recognizing age specific differences in assessing the needs of the patients.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Must be courteous to patients, visitors, physicians, volunteers, and other employees of the organization.

Provides services which comply with: Public Health, JCAHO, Medicaid, Medicare, HMO's and PRO regulations.

Screens all admissions to the hospital to determine whether discharge planning services may be needed.

Screens and assesses patients who fall into "high risk" categories in compliance with the DPH regulations.

Provides assessment of social, emotional, financial and discharge planning needs of hospital patients on all units, medical/surgical, pediatrics, maternity, emergency room, geriatrics, ambulatory care using knowledge and skill in applying the principles of growth and development in these areas.

Assesses and refers outpatients when required.

Provides therapeutic short term counseling to patients and families.

Coordinates discharge planning with patients, families, physicians, staff and community agencies and facilities recognizing each patient's requirements relative to their age-specific needs.

Determines the type and amount of home care services required by patients and arranges for their care.

Determines level of care for patients who need nursing home care.

Communicates diagnoses and activities of daily living status to nursing home staff.

Coordinates and documents weekly multi-disciplinary rounds to assure that patients in-hospital continuing care needs are met.

Provides mental health and substance abuse assessments of hospital patients, recognizing each patients requirements relative to their age-specific needs. Works with psychiatrists in assessing and treating psychiatric patients. Make referrals for inpatient psychiatric care and/or outpatient mental health treatment.

Assists in the coordination of child abuse and elder abuse procedures.

Assists physicians and hospital staff with their mandated reporting obligations.

Arranges foster care or adoptions for newborns of maternity patients who choose this option.

Coordinates and leads patient focused conferences with physicians, nurses and other staff when the need arises.

Provides social work support and education for patients and families through special projects such  as Cardiac Rehab or cardio pulmonary rehab.

Provides crisis intervention during covered hours.

Assists patients and families in filing Medicaid applications with the Department of Public Welfare. Informs patients of Medicaid eligibility regulations.

Delivers and explains to patients and families the Medicare termination of eligibility letter.

Coordinates the flow of information including the preparation of the Patient care referral form between the hospital and other facilities and agencies. Utilizes discretion regarding the appropriate protection and/or use of confidential information.

Prepares and obtains patient or family signature on the written discharge plan provided to all who receive aftercare services as required by the DPH.

Telephone follow-up of selected discharge patients, as required by the DPH.

Maintains social history and current progress notes in patient medical records. Completes correspondence as necessary to expedite appropriate service and referral.

Functions as liaison and maintains strong working relationships with community agencies including extended care facilities, mental health and home care agencies.

Serves on the Psychiatric patient care committee and attends other hospital and community meetings.

Provides training and supervision, as appropriate, for social work students as part of their field instruction.

Participates in the development of in-service programs for hospital personnel addressing the psychosocial needs of patients and families.

Prepares and submits monthly statistical and quality assurance reports.

Assists in fulfilling audits and other federal, state, and JCAHO requirements.

Assists in assuring the utilization of acute hospital beds.

Participates in appropriate conferences, workshops, and courses to enhance and stimulate the professional awareness of innovative medical social work programs and services.

Must wear facility provided identification badge at all times.





QUALIFICATIONS  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



Master's Degree in Social Work. Must be licensed in MA.  Over three months up to and including one year of social work experience.


HR Use Only: MSTR

Zip Code: 02601
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