Care Coordination Master Social Worker
About The Position
As a Social Worker at Virginia Mason Franciscan Health, you will provide compassionate support and guidance to individuals and families facing complex challenges. The role includes psychosocial assessment, care planning, counseling, crisis intervention, connecting clients with resources, advocacy, and collaboration with multidisciplinary teams to promote holistic support and well-being. You will provide developmentally appropriate care across populations, plan for safe discharge and continuity of care, and address the needs of patients of all ages, including people who are physically disabled, mentally ill, chronically ill, terminally ill, or otherwise vulnerable. The position encompasses advocacy and education, psychosocial management, patient and family care conferences, continuity and transition management, and community resource coordination. It includes support related to self-care and health management, bioethics, abuse and neglect, grief, substance use, psychiatric needs, social determinants of health, post-acute care, mental health services, palliative and hospice care, and health-related insurance and support programs. The Social Worker also maintains current community resource information and builds community relationships to address patient needs.
Requirements
- Master's degree in Social Work.
- One year of post-MSW experience or a Social Work internship in a clinical or medical setting.
- Upon hire, one of the following Washington credentials: Licensed Independent Clinical Social Worker (LICSW), Licensed Advanced Social Worker (LASW), Licensed Social Worker Associate Advanced, or Master Social Worker.
Nice To Haves
- Minimum of three years of post-MSW healthcare experience.
Responsibilities
- Provide developmentally appropriate care and plan for safe discharge and continuity of care across patient populations.
- Advocate for and educate patients and families on self-care and health management; provide physician, staff, and community education and case/care management education and training.
- Identify and refer bioethics and risk-management concerns as appropriate.
- Conduct psychosocial assessments and provide crisis intervention, counseling support, and referrals.
- Identify, assess, and refer concerns involving abuse, neglect, or trafficking, including partner, child, and elder concerns.
- Address family issues affecting care, coping and emotional adjustment, grief and bereavement, adoption, surrogacy, safe surrender, health and wellness, substance use, psychiatric needs, and staff support.
- Assess and address social determinants of health, including housing and food insecurity and transportation needs.
- Coordinate interdisciplinary patient and family care conferences related to continuity and transitions of care.
- Facilitate patient decisions and communications regarding post-acute care as part of the Care Management/Coordination team.
- Maintain current knowledge and resource lists for community resources within the clinical social work scope of service; educate patients and families about available resources.
- Coordinate mental health services and support, and provide support, referrals, and management for grave disability, palliative care, end-of-life, and hospice needs.
- Manage and coordinate transition planning for psychosocially complex cases.
- Coordinate community resources, including life-care planning and consultation on health care resource management.
- Educate teams and patients about health-related insurance and support programs, including CCS, Medicare, Medicaid, and SSI.
- Build and maintain community relationships to address the needs of patients experiencing homelessness and other social determinants of health.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
