Social Worker Assistant

Responsibilities

• Receives referrals from providers and other members of the care team for patients who identify/screen positive for barriers to care related to the Social Determinants of Health.
• Provides social work services and/or consultation in collaboration with care managers for patients/families with SDOH problems identified.
• Serves as a liaison and advocate to community agencies regarding services to individual patients and their family system.
• Identifies and intervenes for PCN patients suspected of being victims of abuse, neglect, and/or domestic violence.
• Maintains current knowledge of community resources relevant to the PCN patient population.
• Follows up to evaluate service connectivity (closed loop referrals).

Essential Functions

• Provides outreach and engagement (phone, in person, in home or tele-health).
• Offers supportive, short-term counseling and coaching to facilitate identification of and progress on service goals.
• Shares information, educates, and supports health literacy among patients and families.
• Coordinates referrals to and acts as a liaison with community agencies.
• Assesses and addresses financial barriers to medication access, collaborating with hospital pharmacists and other clinicians to facilitate access to financial assistance programs and resources, including medication vouchers.
• Conducts internal and external systems advocacy as indicated in care plans of individual patients in collaboration with the care managers.
• Maintains accurate and complete record documentation and data collection regarding identified needs and closed-loop referrals.
• Documents all social work activities in the patients' medical record in accordance with relevant policies and procedures.

Professional Development/Administrative Responsibilities

• Participates in team meetings and interprofessional care team meetings.
• Engages in activities of the Social Work Division, including meetings, time reporting, and professional development.
• Attends mandatory in-service training and UHS reviews.
• Participates in professional development with relevance to the position.