Reports To: Clinical Supervisor/Clinical Director, or Master of Social Work

Job Description Summary

To deliver varied social work services to Heartland patients and their families. To provide initial emotional, spiritual, psychosocial assessments, ongoing counseling, bereavement services and community education, outreach, and referral. The social worker is an integral part of the Heartland team.

Essential Job Functions/Responsibilities

  1. Assesses the psychosocial status of patients and families/caregivers related to the patient’s terminal illness and environment and communicates findings to the registered nurse and other members of the interdisciplinary group. Provides an assessment of the patient’s identified residence and assistance when this is not safe, and another plan is required.
  2. Carries out social evaluations, including family dynamics, caregiver abilities, communication patterns, high risks for suicide, neglect or abuse and plans intervention based on evaluation findings. Counsels’ patients and family/caregivers as needed in relationship to stress, and other identified coping difficulties. Provides crisis intervention when necessary.
  3. Assesses for, and educates interdisciplinary group, on any special needs related to the culture of the patient and family. Includes communication, role of family, space, and any special traditions or taboos.
  4. Maintains clinical records on all patients referred to social work prepares clinical and progress notes.
  5. Educates patients and families on, and assists in, preparation of advanced directives.
  6. Provides information and referral services for organization patients and families/caregivers regarding practical and environmental needs.
  7. Provides information to patients and families/caregivers and community agencies.
  8. Serves as liaison between patients and families/caregivers and community agencies.
  9. Maintains collaborative relationships with organization personnel to support patient care.
  10. Maintains and develops contracts with public and private agencies as resources for patient and personnel.
  11. Participates in the development of the individualized plan of care, involving the patient and family, and attends regularly scheduled interdisciplinary group meetings, assisting the team in recognizing the effects of the psychosocial stresses on the symptoms of the terminal illness.
  12. Assists physician and other team members in understanding significant social and emotional factors related to health problems and death/dying issues.
  13. Actively participates in quality assessment performance improvement teams and activities.
  14. Assists family and patient in planning for funeral arrangements, financial, legal, and health care decision responsibilities.
  15. Other duties as delegated by the Clinical Supervisor.

The above statements are only meant to be representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.


Position Qualifications:

A Social Worker must at least meet one of the following options:

  1. Have a MSW degree from a school of social work accredited by the Council on Social Work Education (CSWE), and one year of experience in a health care setting.
  2. Have a baccalaureate degree (BSW) in social work from an institution accredited by the CSWE, and one year of experience in a health care setting and be supervised by a MSW from a school of social work accredited by the CSWE and who has one year of experience in a health care setting.
  3. Have a baccalaureate degree in psychology, sociology, or other field related to social work, and at least one year of social work experience in a health care setting and be supervised by a MSW from a school of social work accredited by the CSWE and who has one year of experience in a health care setting.

Heartland must also defer to State law regarding social work requirements. If State requirements are more stringent, Heartland must comply with State requirements. For example, if the State requires a social worker to have a BSW or and MSW, Heartland may not employ a person with a baccalaureate degree in psychology, sociology or other field related to social work to work as a Social Worker.

Heartland must employ or contract with at least one MSW to serve in the supervisor role as an active advisor, consulting with the BSW on assessing the needs of patients and families, developing and updating the social work portion of the plan of care and delivering care to patients and families. Supervision may occur in person, over the telephone, through electronic communication or any combination thereof. Heartland will allow time for the supervision to happen on a regular basis and provide documentation as to the nature and scope of supervision. Heartland also ensures that non-social work trained bachelor’s prepared employees filling the role of social worker are supervised by a MSW who graduated from a school of social work accredited by the CSWE and who has at least one year of experience in a health care setting.

Physical Requirements:

Required minimal physical effort most of the day including kneeling, squatting, reaching, twisting, climbing, walking, exposure to temperature and humidity changes and minimal assist in lifting and/or transferring of a 20-pound patient. Must possess sight/hearing senses or use appropriate adaptive devices that will enable senses to function at a level required to meet the essential duties of the position. Must provide evidence of annual TB test and other state-required test or examinations.

Mental Requirements:

Must be able to work independently, make judgements based on assessments and data available and act accordingly. Must be flexible, innovative and possess good interpersonal skills. Must be able to cope with mental and emotional stress and demonstrate emotional stability.

Working Conditions:

Be able to tolerate exposure to elements including, but not limited to, odors, blood, body fluids, and excrements, adverse environmental conditions and hazardous materials.


Must have a current calid driver’s license, auto liability insurance and reliable transportation.


Ability to work independently, make accurate, and at times, quick judgments. Ability to respond appropriately to crisis outside of a hospital setting. Acceptance of and adaptability to different social, racial, cultural, and religious modes.


Minimum 2 years of experience as a social worker, preferred. Active patient contact within past three years, preferred.

Job Types: Full-time

Pay: Determined upon experience, skills, education, and training.


  • 401(k) Plan
  • Group Health Insurance Plans
  • Dental insurance
  • Vision Insurance
  • Flexible schedule
  • Paid time off

Medical specialties:

  • Home-Based Healthcare
  • Healthcare


  • Monday to Friday

Work Location: In person

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