Social Worker II

Job Description

Job Summary:

• The Clinical Care Team will receive referrals from primary care staff and will work collaboratively to carry out the following responsibilities.

Duties & Responsibilities:

• Perform case management activities, including.
• Connecting patients to relevant social service resources such as housing, clothing, food, and mental health services.
• Assisting with securing necessary medical equipment.
• Following up on patient care plans to ensure continuity of care.
• Maintain an up-to-date directory of community resources for each county, including eligibility criteria, referral processes, and contact information.
• Support patient education by providing referrals or identifying appropriate educational materials and resources.
• Conduct in-person or virtual social needs screenings and assessments for primary care patients referred by providers.
• Document all activities and communications in the patient’s medical record, coordinating with providers and clinical staff as needed.
• Assist with patient outreach, including identifying high-risk patients who are lost to follow-up or overdue for care, and supporting their return to services as directed by providers.
• Travel throughout the region as necessary to support clinic operations and patient needs.

Additional Expectations:

• Expectations will be communicated by the Regional Leadership Team and may include:
• Completing all onboarding and orientation activities.
• Participating in provider and nursing supervisor staff meetings as appropriate.
• Attending Health Council and other community meetings to build partnerships with social service agencies and promote department services.
• Identifying and addressing barriers to care or assistance that impact patients’ access to needed services.

Required Education & Experience:

• Graduation from an accredited college or university with a bachelor’s, master’s, or doctorate degree in social work and one year of full-time professional social work or social work-related experience.
• Qualifying graduate coursework in social work from an accredited college or university may be substituted for the required year of experience.
• (e.g., 36 graduate quarter hours in social work may be substituted for the one year of required experience).
• Relevant full-time public health experience involving direct client services, community outreach, case management, or care coordination may also be considered in substitution for the required social work-related experience.
• ORPossession of a Master of Social Work Certificate (CMSW) or License of Clinical Social Work (LCSW) from the Client.