Medical Social Worker (MSW)
Core
Provide assessments, advocacy, and care coordination for high-risk patients to improve health status and avoid hospitalizations.
Role type
Medical Social Worker (MSW)
Builds
Comprehensive care plans and psychosocial support services
Domain
Healthcare / Social Work
Required skills
psychosocial assessment, care coordination, community resource navigation, insurance benefits navigation, crisis triage, psychoeducation, documentation, interdisciplinary collaboration
Preferred skills
complex care coordination, population healthcare management, data-driven practice, multidisciplinary team experience
Technologies
Microsoft Office, GSuite, Electronic Medical Records (EMR)
Responsibilities
Conduct comprehensive assessments and telephonic/in-person check-ins; partner with patients to identify goals and address barriers; maintain knowledge of community resources and make referrals; navigate patient insurance benefits; provide longitudinal and episodic care coordination; educate patients on supportive care and end-of-life planning; collaborate with care teams to solve complex psychosocial issues; document interventions; provide clinical guidance to Community Health Workers; respond to crises and urgent needs.
Seniority
Individual Contributor