Home Health Social Worker — Care Coordination & Support

upperlinehealth; Nashville (TN); Sur place; USD 50 000 - 70 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Résumé du poste

Upperline Health is seeking a Social Worker to provide supportive and medical social services to patients and families in the home. You will assess psychosocial needs, coordinate transitions from facility to home, and collaborate with the care team to address health goals and social determinants of health.

Ideal candidates have Medicare experience and a compassionate, detail-oriented approach within a fast-growing team.

Qualifications

• Master's degree in social work from an accredited institution is required.
• Minimum of 3 years social work experience, preferably in a centralized care management team environment.
• Healthcare experience serving chronically ill patients preferred.
• Telephonic case management or care coordination experience preferred.
• Strong customer-service orientation.
• Patient, compassionate and professional demeanor required.
• Exceptional organizational skills and ability to multi-task.
• Self-starter with an entrepreneurial spirit and demonstrated problem-solving skills.
• Strong writing, Word, Excel, and database management skills.
• Experience working in a fast-growing, rapidly changing environment.

Responsabilités

• Assess and address patient and family physical and psychosocial needs in collaboration with the interdisciplinary team.
• Coordinate care and resources, including social support and transportation needs, financial counseling, identifying non-clinical community resources, mitigating family dynamics and patient compliance issues, and assisting patients in logistically accessing available healthcare services.
• Assess, identify and close clinical and non-clinical gaps in patient care.
• Appropriately triage and elevate routine, urgent and emergent patient calls.
• Document social work assessments, care plans, and interventions.
• Provide brief, targeted counseling and intervention for psychosocial, emotional issues related to social determinants of health.
• Collaborate with field-based NPs and physicians to develop and implement effective treatment plans and interventions for complex patient care issues.
• Identify community resources and assist Upperline's patients and families in accessing those resources.
• Complete various clinical and administrative tasks
• Participate in weekly interdisciplinary team meetings
• Complete other related duties as deemed necessary by Upperline Health

Connaissances

Social work skills

Communication skills

Case management

Documentation

Analytical skills

Formation

MSW (Master of Social Work)

Outils

Microsoft Office

Description du poste

Upperline Health is seeking a Social Worker to provide supportive and medical social services to patients and families in the home. You will assess psychosocial needs, coordinate transitions from facility to home, and collaborate with the care team to address health goals and social determinants of health.

Ideal candidates have Medicare experience and a compassionate, detail-oriented approach within a fast-growing team.