High Acuity Social Worker

About the position

Fenway Health is committed to providing comprehensive care to individuals living with HIV (PLWH). Many of our patients face significant social barriers that hinder their ability to engage in healthcare and maintain viral suppression, which can lead to negative health outcomes and increased risk of HIV transmission. The High Acuity Social Worker, reporting to the Administrative and Clinical Managers for the High Acuity Community Health Worker (CHW) Program, ensures that PLWH are appropriately assessed, triaged, and supported while managing a modest caseload (~20 clients at a time) for individual, low barrier 1:1 therapy. This role plays a crucial part in collaborating with High Acuity CHWs, each managing their own caseloads and supporting unenrolled patients in a drop-in setting, to provide crisis intervention and emotional support. Once a PLWH is enrolled and the case is assigned to a High Acuity CHW, the High Acuity Social Worker works closely with the assigned CHW to develop a service plan and delivery process aimed at stabilization and engagement in medical services. The High Acuity Social Worker will also provide 1:1 therapy using a harm reduction approach, and may have the opportunity to develop and facilitate support groups.

Responsibilities

• Conduct initial assessments, including Public Health intake and Ryan White Part A eligibility screening.
• Link clients to culturally competent resources and treatment, focusing on individuals experiencing homelessness, active substance use, recent immigrants, people of color, and/or those identifying as part of the LGBTQ+ community.
• Respond to requests from program staff for routine and crisis interventions, including warm handoffs and support during drop-in services.
• Assist program leadership in managing drop-in services, ensuring clients are promptly connected to a High Acuity CHW.
• Support High Acuity CHWs in developing and updating service plans for enrolled clients.
• Coach High Acuity CHWs to deliver effective care, services, and communication.
• Guide High Acuity CHWs in helping clients develop risk reduction strategies and self-sufficiency skills.
• Provide guidance to High Acuity CHWs on client interactions, modeling appropriate boundaries and care approaches.
• Hold regular 1:1 supervision with High Acuity CHWs, reviewing cases and offering coaching to ensure the delivery of high-quality services and strong interventions.
• Monitor High Acuity CHW caseloads, ensuring proper enrollment, assessment, and discharge processes are followed.
• Support High Acuity CHWs with training, including safety planning and crisis management.
• Provide low-threshold, accessible services to clients in community, office, and remote settings.
• Work closely with High Acuity CHWs to review initial service plans, service plan updates, and discharge summaries according to funder requirements, department standards and in accordance with Fenway policy.
• Attend to the requirements for obtaining and tracking Ryan White and Public Health/ARCH eligibility and timely reassessments of needs.
• Lead program expectations for document collection and High Acuity CHW collaboration.
• Provide consultation to, and collaborate with, other care providers that constitute a client’s health care or public health team.
• Participate in regularly scheduled supervision.
• Participate in staff meetings, training, and continuing education activities of the Fenway Health Prevention and Nursing Departments.
• Adhere to all agency and department policies and procedures.
• Adhere to the highest principles of patient and client confidentiality.
• Attend and actively participate in department and agency meetings, in-services, and trainings.
• Maintain professional competence necessary to perform job responsibilities; maintain and provide agency with credentials and continuing education activities as required.
• Perform other duties as related.

Requirements

• Masters in social work + LCSW in state of MA.
• At least two years of relevant experience.
• Commitment to reducing barriers to accessing medical care and supportive services with low-threshold and risk reduction models.
• Ability to complete documentation in a timely manner, and maintain up to date client care documentation required.
• Flexibility, adaptability, and ability to multitask required.
• Experience and demonstrated competence working with the following populations: LGBTQ, people of color, immigrants, people living with or at risk for HIV/AIDS and/or medical issues, trauma, substance use, homelessness, and mental illness.
• Capacity to work independently and as part of interdisciplinary team.
• Ability to work harmoniously and effectively with colleagues, patients, clients, and vendors across the spectrum of diversity, including but not limited to race, ethnicity, color, gender identity, sexual orientation, age, socio-economic status, national origin, and immigrant status, religious or spiritual identity, disability (physical, mental, emotional, and developmental), veteran status, and/or limited English proficiency.
• Willingness to contribute towards Fenway’s efforts in becoming an anti-racist organization and promoting a culture dedicated to ongoing development in service of humility, equity, diversity, inclusion, and belonging, where differences are acknowledged and valued.

Nice-to-haves

• Minimum of two years of supervisory experience.
• LICSW.
• Experience working with clients who have substance use issues and knowledge of and commitment to using a harm reduction, motivational interviewing, trauma informed, strengths-based and client centered approaches.
• Experience working with an ethnically, culturally, and racially diverse work staff preferred.
• Experience in clinical screening assessment/evaluation preferred.

Benefits

• Competitive salaries.
• Comprehensive medical and dental insurance plans.
• Retirement plan with employer match.
• 12 paid holidays.
• Paid vacation.