Social Worker
Responsibilities
Provide observation, ongoing assessment, and therapeutic intervention consistent with physical and psychological status.
Awareness of services available to patients and their families is an important part of this assessment.
Assess members’ Social Determinants of Health, such as housing, food, transportation, and safety in the home.
Work collaboratively with physicians and community resources including pharmacists, nurses, registered dieticians, and other disciplines to address patient needs as identified in assessments.
Facilitate any necessary follow-up or referrals for behavioral health needs with local behavioral health providers.
Develop, facilitate, and communicate a plan of care in partnership with the member, family (or designated representatives), providers, and multidisciplinary care team to assess the options of care including use of benefits and community resources.
Update care plan to include progress towards achieving established goals and self-management activities.
Carefully coordinate necessary referrals and authorizations pertinent to patient care and well-being.
Utilize developed systems, processes, and initiatives to engage patients in relevant social activities necessary to promote wellness and care at the right place and time.
Identify and utilize cultural and community resources and align with the patient’s cultural preferences as much as possible.
Facilitate the information flow between health representatives and the care team.
Coordinate care and communicate with multiple providers, internal and external to the practice.
Act as a resource for both clinical and non-clinical staff [i.e., care coordinators, dieticians, RN Case Managers].
Attend required training and collaboration sessions [i.e., learning sessions/ practice team meetings] as scheduled.
Provide and facilitate open communication regarding patient status, with physicians and patient care team.
Develop constructive relationships with internal GLIN population health team members, participating providers, and community resources.
Qualifications or Education, Training and Experience
- Valid and current MSW, LCSW or LMSW licensure
- 3-5 years’ care management and/or managed care experience in one of the following settings: acute inpatient, rehabilitation, sub-acute, skilled facility, homecare, ambulatory care management, or managed health plan.
About the Role
The Social Worker will work on a multidisciplinary healthcare team in a primary in person/telephonic setting; focusing on coaching and coordination of care for patients needing navigation and addressing patient care needs and follow up after clinical care.
Benefits
As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program.
You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/.
Schedule
Full Time
Pay
$79,200 - $110,000
Benefits
Comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program.
You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/.