Healthcare Social Worker
7 days ago
About the Role
Oak Street Health is seeking a highly skilled Medical Social Worker to join our team. As a key member of our care team, you will play a vital role in supporting the psychosocial needs of our patients.
Key Responsibilities
- Proactively identify and address the complex needs of our highest-risk patients, providing comprehensive assessments, telephonic check-ins, and in-person visits.
- Collaborate with patients and their support persons to develop personalized care plans, addressing barriers and driving positive outcomes.
- Maintain extensive knowledge of community resources, making referrals as needed to ensure patients' healthcare and psychosocial needs are met.
- Navigate patient insurance benefits in collaboration with the Patient Relations Manager to ensure mindful utilization and maximization of plan benefits.
- Provide longitudinal and episodic comprehensive care coordination, empowering patients to independently manage their health conditions and improve their 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 all care team members have visibility into the status of MSW interventions.
- Partner with Community Health Workers, providing clinical guidance and consultation regarding complex patient needs.
- Respond to crises and urgent needs with the ability to prioritize work, triage situations, and multitask.
Requirements
- Master of Social Work degree 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
- Fluency in Spanish, Polish, Russian, or other languages spoken by people in the communities we serve (where necessary)
- 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
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