Medical Social Worker

Role Overview Join a multidisciplinary team (MDT) comprising doctors, nurses, allied health professionals and community volunteers to deliver holistic social work services to End-Stage Renal Disease (ESRD) patients and their families. You will play a key role in supporting patients’ psychosocial well-being, facilitating access to care, and enhancing their quality of life through case management and programme development. Key Responsibilities 1. Case Admission & Assessment Manage the end-to-end referral and admission process, including intake screening, financial counselling, and dialysis slot allocation Conduct comprehensive psychosocial assessments and develop individualised care plans for patients and their families Collaborate with internal MDT members and external referral partners to ensure smooth care transitions Provide orientation and emotional support to newly admitted patients to ease adjustment into the dialysis centre 2. Case Management Perform regular patient check-ins during dialysis sessions to monitor well-being and build therapeutic relationships Identify and proactively intervene in cases of psychosocial risks, treatment non-adherence, or financial challenges Conduct home or hospital visits where required to better assess patient needs and family dynamics Develop, implement, and review care plans for complex or high-risk cases Advocate for patients and connect them with appropriate community resources and social services 3. Programme Planning & Implementation Design and deliver patient-centric programmes and psychoeducation sessions to enhance well-being and social integration Coordinate programme logistics including venue setup, registration, volunteer involvement, and speaker engagement Monitor and evaluate programme outcomes, incorporating feedback for continuous improvement 4. Volunteer Engagement & Supervision Serve as the main liaison for befriender volunteers, including onboarding, training and ongoing support Review volunteer interaction…