Social Worker - Ambulatory Outpatient Services

Cleveland Clinic • Cleveland, OH

10d • Hybrid

About The Position

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Details Join Cleveland Clinic’s Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family. Here, you will work alongside a passionate and dedicated team, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world. As a Social Worker, you will help patients, families, and groups achieve better health outcomes by identifying and removing barriers that limit access to essential healthcare resources, with a primary focus on supporting underserved communities including individuals managing diabetes, obesity, and related comorbidities. In this role, you will address social determinants of health such as transportation, food insecurity, housing, and medication access, while collaborating closely with community health teams, exercise physiologists, outreach programs, and Endocrinology providers. You will play an active role in community programs, including strong involvement at the Langston Hughes, Lutheran, and Euclid Smart Gym locations, which offer free gym access, health screenings, body composition analysis, and personalized fitness programs. Your work will also support initiatives such as prescription produce programs, food pantry resources, teaching kitchens in development, and diabetes and weight-management support groups. A caregiver in this role works a hybrid schedule from 8:00 a.m. – 4:30 p.m., with three days onsite and two days remote.

Requirements

• Master’s degree in social work (MSW)
• Current state licensure as a Social Worker. Eligible licensures include: LSW, LISW, LISW-S or PC
• Social Work or Case Management certification (CCM) within one year of eligibility
• Basic Life Support (BLS) certification through American Heart Association (AHA) or American Red Cross
• Experience in ambulatory care, hospital patient care or related field
• Knowledge of community resources and ability to coordinate care across transition points in the healthcare continuum
• Excellent communication skills-verbal and written-to work collaboratively with multidisciplinary teams and post-acute providers for optimal patient or population outcomes
• May require periods of standing, sitting and the ability to walk to various locations throughout the campus and enterprise as well as community settings for care planning and to attend meetings.
• Requires good visual and hearing acuity through normal corrected means.
• Requires manual dexterity to document in EHR and work with office equipment and other technology as required.

Responsibilities

• Assist patients, families and groups in achieving improved health outcomes by reducing or removing obstacles that interfere with ability to use health resources effectively.
• Plan interventions based on care coordination, population health and patient-centered medical home philosophies.
• Assess psychosocial risk factors of patient, family, community or population related to level of functioning, appropriate and adequate support systems, ability to cope with adversity and reaction to illness.
• Develop plans of care for patients or populations based on current situation and assess needs of the patient, caregiver and community or the population to be served.
• Participate in care coordination and transition management as patients and populations move across the healthcare continuum.
• Collaborate with post-acute providers to meet the needs of complex patients between ambulatory care visits.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees