Clinic Social Worker - WI GUIDE Program

Advocate Health and Hospitals Corporation•Milwaukee, WI

3d•Hybrid

About The Position

This full-time position will be in-person at the Center for Senior Health and Longevity at the Aurora Sinai Outpatient Center, Monday-Friday during typical clinic hours. The role includes conducting home visits with GUIDE aligned patients and their caregivers. The Clinic Social Worker performs culturally responsive psychosocial screening and assessment to identify social, psychological, behavioral, economic, and environmental needs of outpatients and their families. This includes family needs assessment, assessment of safety and environment risk, and assessment of resource needs. They develop goals related to the social, psychological, behavioral, economic, and environmental needs of the patient and family, in alignment with the patient’s overall health goals, and identify potential risks and barriers to positive health outcomes. The role also involves providing appropriate social work and therapeutic interventions, education on Advance Care Planning, facilitating safe transitions, problem-solving barriers to care access, and serving as an integral member of the health care team.

Requirements

Social Worker license issued by the state of Wisconsin.
Master's Degree in Social Work.
Typically requires 1 year of experience in providing social work services within a complex care system.
Demonstrated knowledge of social work principles and methods, and the ability to apply these in a health care setting.
Demonstrated decision-making, team building, time management, customer service, and conflict resolution skills.
Excellent oral and written communication skills.
Intermediate computer skills including word processing, presentation applications and electronic mail.
Demonstrated organization and time management skills.
Ability to work with a multidisciplinary team.
Must sit, stand, speak, read/write, and walk throughout the workday.
Position may require travel; therefore may be exposed to road and weather hazards.
Operates all equipment necessary to perform the job.
Must be able to lift up to 20 lbs. and use repetitive activities of the fingers, hands and wrists.
Must have functional sight and hearing.

Nice To Haves

May include family needs assessment, assessment of safety and environment risk, and assessment of resource needs.
Includes psychosocial and supportive counseling, health behavior coaching, motivational interviewing, psychoeducation and health literacy, case management, and crisis intervention services.
Assists with the execution of Advance Care Planning documents as necessary.
Incorporates systemic and solution-focused approach to case management and care coordination.
Participates in outpatient care management initiatives as well as strategies aimed at enhancing the patient experience and improving clinic and department quality.
Age-specific information is developed further in the departmental job standards.

Responsibilities

Performs culturally responsive psychosocial screening and assessment to identify social, psychological, behavioral, economic, and environmental needs of outpatients and their families.
Develops goals related to the social, psychological, behavioral, economic, and environmental needs of the patient and family, and in alignment with the patient’s overall health goals.
Identifies potential risks and barriers to positive health outcomes.
Identifies other necessary resources and services both within the health care system and the community which may include safety planning.
Provides appropriate social work and therapeutic interventions to facilitate the execution of the social care plan.
Provides education to patients and families regarding Advance Care Planning for health care decision-making and assists with the execution of those documents as necessary.
Facilitates safe and effective transitions to home and community.
Facilitates smooth handoffs to other professional and community support providers.
Assists with problem-solving and resolution of barriers to access to care.
Incorporates systemic and solution-focused approach to case management and care coordination.
Serves as integral member of health care team supporting team-based approach to care management.
Provides effective communication and collaboration with team members.
Provides patient navigation and advocacy services.
Participates in outpatient care management initiatives as well as strategies aimed at enhancing the patient experience and improving clinic and department quality.
Participates in research activities.
Adheres to evidence-based and industry best practices for professional social work.
Adheres to the social work professional code of ethics and demonstrates decision-making based on ethical principles.
Documents social work activities in accordance with department protocols and standards and in keeping with all relevant federal and state regulations.
Provides strength-based, social work services to diverse patient populations using a cultural humility framework and grounded in principles of trauma-informed care.
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served.
Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program