LCSW — Transitional Care & Home-Visit Specialist

VNS Health; New York (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

VNS Health in Syracuse is seeking a Licensed Clinical Social Worker to join a social work-led team within the Transitional Care Program. You will provide targeted psychosocial assessments and interventions for patients at high risk for rehospitalization during post-discharge transitions.

Responsibilities include home visits, care planning with the team, weekly calls to patients and families, referrals to community services, and documentation in the EMR.

Qualifications

• Current NY LCSW licensure required.
• Master's Degree in Social Work required.
• Minimum four years of direct clinical social work experience or discharge planning in a health care setting.

Responsibilities

• Collaborate with the transitional care team to reduce rehospitalizations.
• Perform home visits and develop care plans with the team.
• Conduct weekly or more frequent phone visits for assessment and support.
• Document clinical notes and progress in EMR for quality reporting.
• Participate in discharge planning and program goals.

Skills

Clinical social work

Home visits

Patient assessment

Crisis intervention

Communication skills

Education

Master's degree in Social Work

Tools

Electronic Medical Record (EMR)

Job description

VNS Health in Syracuse is seeking a Licensed Clinical Social Worker to join a social work-led team within the Transitional Care Program. You will provide targeted psychosocial assessments and interventions for patients at high risk for rehospitalization during post-discharge transitions.

Responsibilities include home visits, care planning with the team, weekly calls to patients and families, referrals to community services, and documentation in the EMR.