UPMC Community Medicine Incorporated (CMI) is hiring a full-time Social Worker to join their team including 4 other Social Workers! In this position, you will work Monday-Friday from 8:00am-4:30pm. The Social Work team engages with patients telephonically or via telemedicine encounter. Outreach can include elderly care needs, LGBTQ+ needs, homelessness needs, grief counseling needs, domestic violence, placement resources, etc. Once training is completed, this position is work from home but allows flexibility to work from a CMI office location if needed. Candidates living within 60 miles of Pittsburgh will be considered. **Purpose:** Provide brief problem focused assessments, psychosocial support to include end of life and bereavement services, and timely and appropriate discharge planning based on anticipated needs. **Responsibilities:** + Maintain extensive knowledge of federal, state and local assistance programs and community resources that affect patient needs. + Educate and advocate for patients and families to enhance their ability to make informed decisions regarding medical care, discharge planning, advance directives and end of life care. + Demonstrate a knowledge of reimbursement systems, the ability to educate patients and families regarding payer requirements / coverage for post-acute care services and the ability to effectively advocate on behalf of the patient. + Continue to monitor and evaluate the plan of care, options and available services throughout the hospital stay to effectively meet the patient and family's need. Reassess the plan of care as status changes or at a minimum of every 3 days. + Demonstrate the ability to identify, assess, counsel and effectively intervene with medically and psychosocially complex patients. + Collaborate effectively with the healthcare team, patients and families and relevant community resources to develop and implement and individualized plan of care. + Demonstrate appropriate professional practice, maintaining respect for confidentiality and freedom of choice as outlined by the Code of Ethics by the National Association of Social Workers as well as the State Board of Social Workers, Marriage and Family Therapists and Professional Counselors. + Provides accurate, timely and appropriate documentation of all social work interventions in the medical record per regulatory policies and procedures. + Complete a psychosocial assessment that includes social, economic, cultural, age-related and behavioral factors, history of child, elder or domestic abuse, prior psychiatric or substance abuse treatment, family and social support systems and all other available resources as appropriate to the clinical situation. + Demonstrates expertise in accessing social systems by providing resource-specific information to patients and families, initiating contact with appropriate resources and facilitating the patient / family's ability to accept referrals. Bachelor of Social Work (BSW - BASW) degree required from a school accredited by the Council on Social Work Education. **Licensure, Certifications, and Clearances:** + Act 34 **UPMC is an Equal Opportunity Employer/Disability/Veteran**