Social Worker Care Management/Palliative Care

Lakewood Health System•Staples, MN

25d

About The Position

About Lakewood Lakewood Health System is a comprehensive rural healthcare system in central Minnesota. Leading the way in providing quality, personalized healthcare for a lifetime, Lakewood prides itself on remaining fiercely independent to prioritize its patients, staff, and communities in all decisions. Voted as one of Star Tribune’s Top Workplaces for the sixth year in a row, we do rural healthcare differently at LHS by providing a solid foundation of family practice providers with access to best-in-class specialty services, all right here at Lakewood. Across the spectrum of life, Lakewood Health System provides compassionate, quality care for the Brainerd Lakes region and beyond. About the Team Lakewood Health System’s Social Services team is a group of highly engaged individuals working with our patients to provide quality patient care. This team works collaboratively with the interdepartmental teams throughout Lakewood as well as our community-based partners. Mission for Position We are seeking a compassionate, detail-oriented, and experienced Care Management/Palliative Care Social Worker to join our team. In this role, you will collaborate with healthcare providers to support patients through their chronic care journey, assess their needs, and provide social services that foster their well-being. You will play an essential role in helping patients manage their health conditions and improve overall quality of life.

Requirements

Current LSW; valid License with the Minnesota Board of Social Work

Nice To Haves

Experience in a healthcare setting, particularly in care management, case management, or social work.
A highly motivated individual who is willing to work both independently and collaboratively with our patients.
Strong knowledge of community resources and healthcare systems.
Excellent communication and interpersonal skills.
Ability to work collaboratively in a fast-paced, multidisciplinary team environment.
Empathy and cultural competence in working with diverse populations.
Proficiency in using electronic medical records (EMR) systems.
Strong organizational and problem-solving skills.

Responsibilities

Develop, implement, and monitor individualized care plans in collaboration with physicians, interdisciplinary care teams, patients, and caregivers.
Assess patients’ social, emotional, and healthcare navigation needs; provide follow-up, crisis intervention, and ongoing outreach as appropriate.
Serve as a primary liaison between patients, families, clinics, and multidisciplinary teams to ensure coordinated, patient-centered care.
Facilitate access to community, financial, specialty, and social resources to address barriers such as transportation, food insecurity, insurance, and chronic disease management.
Support patients with serious, advanced, oncology, and community-based palliative care needs, ensuring continuity of care and smooth transitions.
Maintain accurate, confidential documentation and actively participate in interdisciplinary meetings to optimize patient outcomes.