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Cross Continuum Social Worker- BSW

UnityPoint Health

Company : UnityPoint Health

Location : Fort Dodge, IA, 50501

Posted Date : 24 September 2025

Job Type : Other

Category : Community & Social Service

Occupation : Social Worker

Job Details

  • Area of Interest: Behavioral Health Services
  • FTE/Hours per pay period: 1.0
  • Department: Care Management- Ambulatory
  • Shift: Monday-Friday 8a-5p
  • Job ID:
Overview

As a member of the interdisciplinary team, contributes professional social work knowledge and skills in the provision of services that support patient and family access to health care and address psychosocial factors that influence a patient's health. This team member will serve patients from Family Medicine Kenyon Road Clinic, 2nd Ave Family Medicine Clinic, and Manson Family Medicine Clinic.

Why UnityPoint Health?

At UnityPoint Health, you matter. We're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in. Here are just a few:

  • Expect paid time off, parental leave, 401K matching and an employee recognition program.
  • Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
  • Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities

Patient Care

* Performs psychosocial assessment of the patient to identify priority needs, strengths, patient preferences and barriers to care.

* Provides crisis intervention and supportive counseling to patients/families to support their ability to cope with the impact of health conditions.

* Educates patient/family regarding Advanced Directives and facilitates/documents advanced care planning conversations with patients/surrogate decision makers including First Steps and IPOST/IPOLST.

* Maintains comprehensive knowledge of community resources and acts as a liaison to refer patients/families to health and social services, health insurance, public assistance and other resources to meet patient identified needs.

* Assists with planning for care transitions and collaborates with UPH, community services, and facilities to support patient safety and continuity of care.

* Completes PASRR or other screening tools when appropriate for transition to another care provider.

Education and Advocacy

* Serves as a patient/family advocate in support of patient confidentiality, informed consent, patient autonomy, and self-determination.

* Assesses patient safety to identify possible abuse, neglect or other risks to safety. Collaborates with the care team to address safety issues and files DHS reports and/or guides others in the process as mandated.

* Provides information and support with guardianship and conservatorship issues.

* Supports culturally competent services and assists with arranging interpreter services as needed.

* Provides education to the patient/family regarding available services and supports and assists the patient to access those they are eligible for.

* Provides information and education to physician and other team members in understanding the psychosocial implications of illness and disease progression for the patient/family.

* Participates in mentoring new employees and/or supervising social work interns as requested.

Care Coordination

* Provides expertise and plays a key role with the care team in establishing patient-centered goals of care and identifying psychosocial and behavioral strengths and barriers.

* Facilitates and/or participates in interdisciplinary team meetings to review and revise the patient plan of care.

* Facilitates patient/family meetings to enhance family support of the patient's care.

* Collaborates with social workers and other professionals across the continuum and in the community to ensure continuity of care.

Qualifications

Education:

Bachelor's degree in social work from an accredited school of social work


Experience:

Prefer one year clinical experience in healthcare

License(s)/Certification(s):

Current licensure in good standing to practice in the state where services are provided (BSW)

Valid Mandatory Reporter course completion by state requirement

Completion of First Steps (ACP) and IPOST/POLST training

LMSW or LISW preferred.

Knowledge/Skills/Abilities:

* Knowledge of the social work process

* Awareness and sensitivity to cultural diversity

* Knowledge of the physiological elements of illness and impact on psychosocial functioning

* Knowledge of the healthcare system and resources available to patients.

* Strong interpersonal skills and ability to work as a collaborative team member

* Knowledge of social determinants of Health

* Strong verbal and written communication skills

Other:

* Use of usual and customary equipment used to perform essential functions of the position.

* Work may require travel to other UPH facilities or patient homes. May drive a UPH vehicle, rental or own vehicle.

* Valid licensed driver with automobile insurance in accordance with state and/or organizational requirements.

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