Social Worker - BSW, Part-Time 20/hrs.
Provides a variety of direct services to clinic patients to improve continuity of care and to help patients and families resolve socio-economic problems associated with adjustment to physical illness and mental health problems, resource needs, and a variety of life events and transitions that can interfere with the patient's ability to access mental health care and fully meet treatment goals.
Specific Duties and Responsibilities
Provides assessment, education, referral and care coordination services to high-risk patients or high utilizer patients in the post-acute care space. Conducts Social Determinants of Health (SDOH) screening with identified patients to assess for environmental needs and barriers to patient achieving optimal health status, such as lack of appropriate housing, transportation, food, etc. Enlists appropriate community resources to address identified needs. Provides referral and linkage to health care and community resources.
Coordinates the care of identified high-risk patients within the clinic. Collaborates with the patient, the clinical care team and possibly the primary care provider and family to develop a plan to address and manage issues which influence mental health care utilization.
Systematically identifies and addresses barriers and fragmentation of care while proactively/collaboratively problem solving to find solutions. Specifically:
- Eliminate barriers to treatment
- Enhance patient's health status
- Increase patient/family satisfaction
- Improve appropriate utilization of resources
Acts as liaison between inpatient and outpatient care settings to ensure continuity of care throughout each site of care, and to ensure communication about and adherence to the established plan of care for each patient.
Other Functions and Responsibilities
Performs other duties as assigned.
REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE
Bachelor's Degree in Social Work from a school accredited by the Council of Social Work Education (CSWE) is necessary. One year experience in community or health-related agency or equivalent experience. Must have LLBSW or LBSW.
REQUIRED SKILLS AND ABILITIES
Interpersonal skills necessary to obtain information from and communicate effectively with patients, other SJMH staff, and community agencies or providers. Ability to establish patient relationships effectively and quickly.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.