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Medical Social Worker
2 months ago
Job Summary:
Oak Street Health Inc. is seeking a highly motivated and experienced Medical Social Worker - Care Coordinator to join our team. As a Medical Social Worker - Care Coordinator, you will play a key role in providing comprehensive care coordination services to our patients, ensuring they receive the best possible care and support.
Key Responsibilities:
- Provide comprehensive assessments, telephonic check-ins, and in-person visits to support our highest-need patients.
- Partner with patients and their support persons to identify goals, increase engagement in their healthcare, address barriers, and drive the execution of their care plan.
- Maintain extensive knowledge of community resources and make referrals, as appropriate, to help ensure patients' healthcare and psychosocial needs are met.
- Navigate patient insurance benefits in collaboration with the Patient Relations Manager (PRM) to ensure mindful utilization and maximization of plan benefits.
- Provide both longitudinal and episodic comprehensive care coordination with the ultimate goal of empowering patients to independently manage their health conditions and have increased 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 at all stages of the patient journey.
- Provide psychoeducation to patients and families surrounding life stage and disease-specific issues, including dementia, adjustment to illness, aging, caregiver support, etc.
- Meet with care teams to collaborate and generate creative solutions to patient issues, and spearhead intervention in situations with complex psychosocial dynamics.
- Complete concise and comprehensive documentation on time to ensure that all care team members have visibility into the status of MSW interventions.
- Partner with Community Health Workers and provide clinical guidance and consultation regarding complex patient needs to these team members.
- Respond to crises and urgent needs with the keen ability to prioritize work, triage situations, and multitask.
Requirements:
- Master of Social Work degree required from a school of social work accredited by the Council on Social Work Education (CSWE).
- Minimally licensed in the state where OSH Center is located.
- Proficient computer skills (including Microsoft, GSuite, and electronic medical records).
- US work authorization.
Preferred Qualifications:
- Prior experience with complex care coordination and/or population healthcare management.
- Familiarity with using metrics and data to guide practice and drive outcomes.
- Minimum one year of medical social work experience in a healthcare environment, preferably within the last two years.
About Oak Street Health Inc.:
Oak Street Health Inc. is a mission-driven organization that is committed to rebuilding healthcare as it should be. We provide personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patients' communities, and focused on the quality of care over volume of services.
Benefits:
- Mission-focused career impacting change and measurably improving health outcomes for Medicare patients.
- Paid vacation, sick time, and investment/retirement 401K match options.
- Health insurance, vision, and dental benefits.
- Opportunities for leadership development and continuing education stipends.
- New centers and flexible work environments.
- Opportunities for high levels of responsibility and rapid advancement.
