Social Worker, LMSW

Distro•New York, NY

1d•Onsite

About The Position

We are seeking a compassionate, organized, and clinically skilled Social Worker, LMSW to provide psychosocial assessment, care management, counseling coordination, participant advocacy, caregiver support, and community-resource coordination. As a member of the Interdisciplinary Team (IDT), the Social Worker completes initial assessments and reassessments, identifies psychosocial needs, develops social work components of individualized care plans, coordinates interventions, monitors participant status, and advocates for participants and caregivers. Recommendations and services should account for each participant’s medical, physical, emotional, social, cultural, spiritual, financial, and family circumstances. The role also involves educating participants, caregivers, and staff about aging, dementia, grief and loss, end-of-life considerations, chronic disease, family dynamics, and the care model. The Social Worker works independently while collaborating with an interdisciplinary healthcare team and maintains timely, accurate electronic health record documentation. The position requires an active New York State LMSW license, a master’s degree in social work, at least one year of post-MSW experience, a valid driver’s license, and current BLS certification or willingness to obtain it. This is a full-time, exempt position with an annual salary of $70,000. The proposed schedule is 40 hours per week, Monday through Friday, 8:00 a.m. to 4:30 p.m. Additional details about benefits, paid time off, retirement, and insurance eligibility are to be confirmed before the public posting is finalized. The position requires travel or driving as needed to fulfill participant-care and program responsibilities.

Requirements

Master’s degree in Social Work from an accredited college or university.
Current New York State Licensed Master Social Worker (LMSW) license and certification; ability to maintain active licensure throughout employment.
At least one year of post-MSW professional experience.
Strong psychosocial assessment and care-planning skills.
Ability to provide case-management and counseling-coordination services.
Excellent interpersonal, written, and verbal communication skills.
Ability to work cooperatively within an interdisciplinary team and independently as needed.
Strong organization, prioritization, and follow-up skills.
Ability to communicate effectively with participants, caregivers, colleagues, supervisors, service partners, and healthcare professionals.
Ability to build effective professional relationships and maintain confidentiality and professional boundaries.
Participant-centered and culturally responsive approach to care.
Proficiency with Microsoft applications and ability to learn and navigate EHR platforms.
Strong clinical-documentation skills and ability to maintain accurate electronic records.
Comfort using technology for meetings, communication, care coordination, referrals, and documentation.
Current BLS certification or willingness to complete the required certification.
Valid driver’s license and ability to travel or drive as required for participant-care and program responsibilities.
Before providing participant care, complete required communicable-disease medical clearance, maintain required immunizations and vaccinations, and meet applicable organizational and healthcare-program screening requirements.
Have no disqualifying convictions involving Medicaid, Medicare, health insurance, healthcare programs, social-services programs under Title XX, physical abuse, sexual abuse, drug abuse, or alcohol abuse.
Not be excluded from participation in Medicare or Medicaid programs and maintain required professional license, certification, and employment eligibility throughout employment.

Nice To Haves

At least one year of experience working with a frail or older adult population; candidates without this experience must complete appropriate provided training before delivering direct participant care.
Two or more years of experience in a health-related setting or social work experience in a health-related setting.
Experience with frail or medically complex older adults in geriatric, home-care, adult-day-health, skilled-nursing, rehabilitation, hospice, hospital, behavioral-health, or community-health settings.
Experience conducting comprehensive psychosocial assessments.
Experience supporting individuals with dementia and their caregivers.
Experience with grief, loss, chronic illness, and end-of-life conversations.
Knowledge of Medicaid eligibility and participant share-of-cost requirements.
Knowledge of New York State nursing home Level of Care requirements.
Experience using Electronic Health Records.
Experience coordinating community resources and social-service referrals.
Current BLS certification.
Strong knowledge of aging services and community resources.

Responsibilities

Complete comprehensive initial social work assessments for new participants and required reassessments for existing participants; conduct additional assessments when participant circumstances change.
Assess participants’ emotional, social, cultural, behavioral, environmental, financial, spiritual, and family circumstances, including strengths, risks, needs, preferences, support systems, and barriers to care.
Document assessment findings accurately and communicate significant concerns to the Interdisciplinary Team (IDT).
Participate in IDT, participant-review, care-planning, and morning meetings; collaborate with healthcare and service professionals.
Develop social work components of individualized care plans, recommend interventions, monitor their effectiveness, and update recommendations as participant needs change.
Provide direct social work and care-management services according to participants’ care plans and coordinate social, psychological, emotional, and spiritual support.
Help participants and caregivers navigate healthcare, benefits, housing, transportation, social-service, and community-resource systems; follow up on referrals and access to services.
Provide or coordinate counseling and supportive interventions within the scope of the LMSW role; support participants and families dealing with aging, disability, chronic illness, grief, caregiver stress, family conflict, and emotional distress.
Identify behavioral-health, safety, abuse, neglect, or crisis concerns and escalate them according to organizational policy and applicable requirements.
Educate participants, caregivers, and staff about aging, dementia, disease processes, grief, loss, end-of-life considerations, the service-delivery model, and care expectations.
Maintain knowledge of community resources, make referrals, liaise with community agencies, track service access, and advocate for appropriate resources.
Promote participant rights, preferences, dignity, safety, self-determination, and involvement in care planning; communicate participant and caregiver concerns to the appropriate team members.
Monitor changes in participant health, psychosocial status, behavior, emotional well-being, family support, and living circumstances; communicate significant changes and update goals and interventions as necessary.
Maintain working knowledge of Medicaid financial eligibility, documentation, participant liability, and share-of-cost requirements; help participants understand processes and escalate complex questions.
Maintain knowledge of New York State nursing home Level of Care requirements and coordinate psychosocial information relevant to participant review and eligibility.
Complete timely, accurate, complete, objective, and confidential social work documentation in the Electronic Health Record (EHR), including assessments, interventions, referrals, communications, and follow-up.
Support Quality Improvement activities, identify opportunities to improve care and service processes, contribute to quality reviews, and follow corrective-action requirements.