Clinical Social Worker

Essential Duties and Responsibilities

• Manage a caseload of high-risk socially complex patients
• Conduct face to face and telephonic psychosocial assessments with the patient and/or the caregiver
• Investigate psychological and social determinant barriers and design appropriate interventions to assist in closing gaps in care and needs
• Provide short-term counseling services as needed
• Coordinate services to ensure the patient/family understands a treatment plan
• Work as part of a collaborative care team to achieve optimal quality and patient experience outcomes, including being an active member in High-Risk Huddles
• Provide outreach to community-based services to support the patient’s ability to age at home
• Develop and implement shared goals of care with the patient and family
• Work with Community based agencies to develop relationships and provide appropriate resources to assist in maintaining patient independence

In this role you may work with. . .

Required Knowledge, Skills and Experience

• Master’s degree in social work
• Must be licensed as an LCSW or LISW (depending upon state)
• Must maintain a valid driver’s license and good driving record
• The ability to use sound clinical judgment and communicate clearly in both written and verbal formats
• Above average computer skills
• Ability to be self-directed and able to communicate effectively with professional staff across many disciplines and programs
• Must have the ability to plan time effectively, balance multiple tasks, work within stringent time frames, resolve problems, identify patient service trends, determine system improvements, and implement change
• Ability to share expertise with others and demonstrates an understanding of the need to foster performance improvement while achieving patient satisfaction and efficiency

Preferred Knowledge, Skills and Experience

• Experience in Care Management in community-based setting or equivalent
• Experience working with the chronic, complex and/or behavioral health population