We are seeking a highly motivated and experienced Senior/ Social Worker to join the Community Care team. Reporting to the Manager, you will play a critical role in providing casework management and counselling through social work assessments and interventions for End Stage Renal Disease (ESRD) patients (BPSS, Risk & Needs Matrix, Case Intervention Plans, etc). Your responsibilities are as follows:
1. Case Management and Intervention
- Manage ESRD patients in dialysis centres or home dialysis (HD/PD) through client engagement, conducting interviews, data collection, case assessment (BPSS, risk & needs assessment, and other relevant assessment tools), case conceptualisation, case planning, and intervention plans for best patient outcomes.
- Identify presenting/underlying issues and problems to design a care plan to enhance/maintain and promote the psychosocial functioning of patients.
- Conduct FFRs (Financial Fee Reviews) and placement on NKF subsidies and welfare programmes.
2. Counselling and Support
- Conduct visits to dialysis centres, homes, or hospitals to provide supportive counselling.
- Facilitate patient and caregiver support group programmes.
- Advocate for the protection of patient's dignity, confidentiality, and rights.
3. Collaboration and Networking
- Collaborate with healthcare professionals internally and externally in total patient management.
- Network with government, community, social agencies, or individuals to mobilise social resources to meet patient’s needs.
4. Documentation and Reporting
- Document bio-data of patients and interventions in the clinical system for records, complete timely online case documentations (case session recordings, follow-up recordings, risk and needs assessment, social reports, patient feedback forms, etc.).
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