Reports to Care Management Social Services Program Manager, the Licensed Social Worker (LSW) is a member of the Care Management – Integrative Care Team. This role helps in population health by accessing community resources and navigating the patient through various systems that are cumbersome and difficult to navigate as a layperson The LSW will also be responsible for face-to-face encounters with patients when necessary in various locations within their region such as in the primary care office, Medicaid office, Library and patient’s home.
The LCW helps with DME, medication assistance programs, food/housing/transportation/WIC/SSI/SSDI/Medicaid application, food stamps, Medicare, Long-term housing, safety needs, etc. This role provides direct communication with physicians, integrative care specialists, nurses, health-care advocates, care coordinators; DME companies; community partners and agencies; lawyers; housing entities; etc. The LSW works closely with the entire integrative care team and primary provider to provide optimal services to the patient.
The LSW demonstrates respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. The LSW is responsible for creating a positive impression with patients, physicians and other visitors he/she encounters, both in person and on the phone.
Social Worker (BSW)- Location: Indiana Multiple Locations Required Stevens Amendment Disclosure: This Rural Health Transformation Program is supported by the Centers for Medicare & Medicaid Services (CMS) of the U. S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $206,927,896.80 with 100 percent funded by CMS/HHS.
The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U. S. Government
No on call No Nights, Holidays, or Weekends Paid Time Off Medical, Dental, and Vision 403b with Match Opportunity for Career Growth LICENSES &
Licensed Social Worker (LSW) - Kentucky Board of Social Work (KYSW) Licensed Social Worker (SW) - Indiana Social Worker (INSW)
BSW degree accredited program. YEARS OF
0-3 years. DUTIES &
1. Comply with all applicable laws and regulations. 2. Provides patient centered evaluation and care planning, resource coordination, and health and safety education during community paramedicine home visits.
Psychosocial Assessment & Communication: 1. Manage a caseload of patients that have been assessed as high risk and patients with high utilization of the health care system. Gather all relevant data, objectively evaluate data, and obtain information by communicating with the patient/patient’s family, the Primary Care Physician, other members of the healthcare team, and patient’s community support network. 2.
Initiate contact with patient/family via phone within 1 business day from referral date. 3. Complete social determinate needs assessment that holistically assess the patient. 4. Identifies barriers and works with patient/family to resolve them. 5.
Complete face to face visits with patients as necessary. Face to face visits can be held in the PCP office, community setting or home environment. 6. Assist with patient’s requests in a timely manner. 7.
Communicates appropriate and applicable information on chart in accordance with HIPPA guidelines. Team Consultation & Collaboration: 1. Completes thorough chart review upon receiving a social work referral 2.
Shares information with Integrative Care Specialists, Care Coordination Staff (HCA’s, CTT), Practice Physicians or APRN/PA and office staff related to social needs and treatment issues of patient. 3. Participates in ongoing communication with physician and interdisciplinary team to develop a collaborative relationship aimed at improving clinical treatment goals 4. Attends site and provider meetings to promote patient-centered teamwork. 5.
Attends and actively participates in department meetings and case consultations as scheduled. Documentation: 1. Documents all visits and phone contacts accurately and in a timely manner. 2.
Identifies and documents all interventions and case closure plans in EPIC. Resource Identification: 1. Provides education on community support services and makes appropriate referrals as needed. 2.
Continuously seeks to increase the quality and value of services provided to our patients/family and health care teams. Patient/Family
1. Builds rapport with patients/family and healthcare teams. 2. Educates patients through providing resources, timelines, and goals for improving their accountability and collaboration in taking part in their health program and medical plan 3.
Proactively makes appropriate referrals and communicates with family and other community resources to best meet the needs of patient’s and family. 4. Act as a liaison between patient/family and all members of the healthcare team. 5. Works with patient/family/healthcare providers/community supports to coordinate needed services. 6.
May provide and assist with support group activities. 7. Provide yearly staff education on social determinate needs and Suicide protocols for the primary care office. 8. Engage and provide education to community partners on role and services.
Employee Care: 1. Behavior Standards a. Communicates effectively with co-workers and healthcare team to ensure continuity of care and service. b.
Resolve issues or problems in a direct, open and constructive manner. c. Honors the dignity of every individual in all interactions. d. Integrates knowledge, skill and experience to continuously improve self and the quality of patient care. e.
Values feedback as an opportunity to learn. 2. Personal Growth and Development: a. Maintains skills and knowledge as appropriate to the medical social work role.
Participates in continuing education to fulfill licensure requirements. 3. Performance Improvement: a. Assists in the process to evaluate patient outcomes, financial and clinical results that can be tracked to measure success of the Social Service Department. 4.
Comply with all applicable laws and regulations.
AND KNOWLEDGE: 1. Demonstrated ability to work successfully in a team-based decision-making culture. 2. Demonstrated ability to work independently resulting in effective outcomes and on-time performance. 3.
Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events. 4. Must respond and follow through to requests from customers promptly. 5. Must work carefully and precisely with attention to detail. 6.
Must utilize resources wisely. 7. Performs duties willingly and with initiative. Shares necessary information so co-workers can do the same. 8.
Cooperates with other departments and work groups. FLSA Status: Exempt Right Career. Right Here.
If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.
St. Elizabeth Physicians is an equal opportunity employer and will not discriminate on the basis of race, color, sex, religion, national origin, ancestry, disability, age or any other characteristic that is protected by state or federal law.