Medical Social Worker (Bilingual Spanish Preferred)
Core
Provide assessments, advocacy, and comprehensive care coordination for highest-risk patients and caregivers to improve health status and avoid hospitalizations.
Role type
Medical Social Worker (IC)
Builds
Care plans and psychosocial support interventions for high-risk patient populations
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 generate solutions for complex psychosocial dynamics; document interventions; provide clinical guidance to Community Health Workers; respond to crises and urgent needs.
Seniority
Mid-level, hands-on IC