Medical Social Worker

CVS Health•Marietta, GA

6d•$46,597 - $101,228

About The Position

The Medical Social Worker is a key member of Oak Street Health Centers, contributing a psychosocial perspective to care teams and supporting patients’ psychosocial needs. In collaboration with the interdisciplinary care team, this role provides assessments, advocacy, and comprehensive care coordination for high-risk patients and their caregivers to help improve health status and avoid hospitalizations. The position reports to the Practice Manager and is full time, with anticipated weekly hours of 40.

Requirements

Master of Social Work degree from a school accredited by the Council on Social Work Education (CSWE).
At least a state-level social work license in the state where the Oak Street Health Center is located (LCSW/LSW).
Fluency in Spanish, Polish, Russian, or another language spoken in the communities served, where necessary.
Proficient computer skills, including Microsoft, GSuite, and electronic medical records.
US work authorization.
Experience conducting patient or client home visits.
At least 2 years of experience as a Medical Social Worker.
Motivation, experience, a problem-solving orientation, a flexible and positive attitude, and a drive to improve the lives of the individuals served.
Passion for working with Medicare-eligible populations, including older adults, adults with disabilities, and adults with severe and persistent mental illness.

Nice To Haves

Prior experience with complex care coordination and/or population healthcare management.
Familiarity with using metrics and data to guide practice and drive outcomes.
Three years of medical social work experience in a healthcare environment, preferably within the last two years.
Experience working on a multidisciplinary team of other healthcare providers.

Responsibilities

Provide comprehensive assessments, telephonic check-ins, and in-person visits for highest-need patients.
Partner with patients and, when necessary, their support persons to identify goals, increase healthcare engagement, address barriers, and carry out care plans.
Maintain knowledge of community resources and make referrals to help meet patients’ healthcare and psychosocial needs.
Work with the Patient Relations Manager to navigate patient insurance benefits and support mindful utilization and maximization of plan benefits.
Provide longitudinal and episodic comprehensive care coordination to empower patients to manage their health conditions and improve their quality of life.
Educate patients on supportive care options, including advance care planning and end-of-life care, and provide goals-of-care counseling, support, and advocacy throughout the patient journey.
Provide psychoeducation to patients and families about life-stage and disease-specific issues, including dementia, adjustment to illness, aging, and caregiver support.
Collaborate with care teams to develop solutions to patient issues and lead interventions involving complex psychosocial dynamics.
Complete concise, comprehensive documentation on time so care team members can see the status of Medical Social Worker interventions.
Partner with Community Health Workers and provide clinical guidance and consultation on complex patient needs.
Respond to crises and urgent needs by prioritizing work, triaging situations, and multitasking.
Perform other duties as assigned.