Social Worker - Primary Care At Home
Core
Provide social work services, assessments, and discharge planning for adult and geriatric homebound patients in their residences and via telehealth.
Role type
Licensed Social Worker (Home-Based Services)
Builds
Seamless and safe discharge plans and community linkage for patients with complex psychosocial and economic needs.
Domain
Healthcare / Home-based care / Geriatrics
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
psychosocial assessment, discharge planning, crisis intervention, psychotherapy, care coordination, resource referral, treatment plan development, supervision
Preferred skills
clinical social work expertise, maternal/child population experience, advanced clinical skills in mental health and addictions
Technologies
telehealth platforms
Responsibilities
Travel to patient homes to deliver services; collaborate with care teams for screening, assessment, and discharge planning; provide crisis-oriented psychotherapy; supervise and train lower-level social workers; advocate for patients and families regarding financial and guardianship issues; administer psychosocial functioning tests.
Seniority
Mid-level, hands-on IC with potential for supervision
