Medical Social Worker

CVS Health • Aurora, CO

13d

About The Position

The Medical Social Worker is a key member of Oak Street Health Centers, contributing a social work perspective to care teams in support of patients’ psychosocial needs. In collaboration with the interdisciplinary care team, the Medical Social Worker provides assessments, advocacy, and comprehensive care coordination for high-risk patients and their caregivers to help improve health status and avoid hospitalizations. The role supports patients through longitudinal and episodic care coordination, education, referrals, insurance-benefit navigation, and advocacy, with the goal of helping patients manage health conditions and improve quality of life. The position reports to the Practice Manager.

Requirements

• Master of Social Work degree from a school of social work accredited by the Council on Social Work Education.
• At least a minimal social work license in the state where the Oak Street Health Center is located.
• 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.
• Authorization to work in the United States.

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.
• At least one year of medical social work experience in a healthcare environment, preferably within the last two years.
• Experience working on a multidisciplinary team of healthcare providers.
• A problem-solving orientation and a flexible, positive attitude, with motivation to improve the lives of the people Oak Street Health serves.
• Passion for working with Medicare-eligible populations, including older adults, adults with disabilities, and adults with severe and persistent mental illness.

Responsibilities

• Provide comprehensive assessments, telephonic check-ins, and in-person visits to high-need patients.
• Work with patients and, when appropriate, their support persons to identify goals, increase healthcare engagement, address barriers, and implement care plans.
• Maintain knowledge of community resources and make appropriate referrals to address patients’ healthcare and psychosocial needs.
• Navigate patient insurance benefits in collaboration with the Patient Relations Manager to support mindful use and maximization of plan benefits.
• Provide longitudinal and episodic comprehensive care coordination to empower patients to manage their health conditions and improve quality of life.
• Educate patients about 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 and comprehensive documentation on time so care-team members can see the status of social work 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.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level