Care Planning Social Worker

Dent Neurologic Group LLP•Town of Amherst, NY

38d•Remote

About The Position

The Remote Care Planning Social Worker is responsible for conducting comprehensive biopsychosocial assessments and developing person-centered care plans using a secure digital care planning platform. This Bachelor level of social worker role engages patients, caregivers, and interdisciplinary team members through telehealth and virtual communication tools to coordinate services, address social determinants of health, and promote optimal outcomes. The position requires strong clinical judgment, technological proficiency, and professional virtual engagement skills.

Requirements

Bachelor’s degree in Social Work (BSW) from an accredited institution.

Nice To Haves

Minimum 1–2 years of experience in case management, care coordination, healthcare, or community-based services preferred by not required.
Experience working with diverse populations, including older adults or individuals with chronic conditions preferred by not required.
Knowledge of community resources and public benefits systems preferred by not required.

Responsibilities

Conduct comprehensive remote assessments (biopsychosocial, risk, needs, strengths-based).
Develop individualized, measurable care plans within a digital care management system.
Identify and address social determinants of health (housing, food security, transportation, financial barriers, etc.).
Coordinate community resources and referrals; document follow-up outcomes.
Monitor progress and update care plans based on patient goals and changing needs.
Escalate clinical or safety concerns to supervisors or licensed clinicians as appropriate.
Conduct scheduled video and phone consultations with patients and caregivers.
Educate patients and families regarding available resources, benefits, and service options.
Facilitate collaborative goal setting that respects patient autonomy and cultural values.
Support caregivers with problem-solving, coping strategies, and care coordination guidance.
Maintain accurate, timely, and compliant documentation in the digital care planning platform.
Ensure all documentation meets organizational, state, and federal requirements (e.g., HIPAA).
Utilize reporting tools to track performance metrics and patient outcomes.
Maintain a private, secure, and distraction-free workspace during all patient interactions.
Use HIPAA-compliant platforms for all communications.
Present professionally during video calls (appropriate attire, neutral background, and clear audio/video).
Begin sessions on time and confirm patient identity and consent for telehealth services.
Use clear, empathetic communication and active listening techniques in virtual settings.
Protect confidentiality by using secure networks and safeguarding login credentials.
Respond to patient and caregiver communications within established service-level timeframes.