Medical Social Worker: Care Coordination & Advocacy

CVS Health; New Britain (CT); On-site; USD 51,000 - 111,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

Oak Street Health in Connecticut is seeking a Medical Social Worker to support psychosocial needs of high‑risk patients, provide assessments, advocacy, and care coordination in collaboration with the interdisciplinary care team.

You will conduct comprehensive assessments, coordinate resources, educate patients on care options including end‑of‑life planning, document interventions, and partner with Community Health Workers to address complex needs.

Qualifications

• Master of Social Work degree required from a school of social work accredited by the 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

Responsibilities

• Proactively support our highest-need patients by providing comprehensive assessments, telephonic check-ins, and in-person visits.
• Partner with the patient 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 the patient’s healthcare and psychosocial needs are met.
• Navigate patient insurance benefits in collaboration with the 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.
• Other duties as assigned.

Skills

Fluency in Spanish

Proficient computer skills

US work authorization

Education

Master of Social Work (CSWE accredited)

Tools

Microsoft Office

GSuite

Electronic Medical Records (EMR)

Job description

Oak Street Health in Connecticut is seeking a Medical Social Worker to support psychosocial needs of high‑risk patients, provide assessments, advocacy, and care coordination in collaboration with the interdisciplinary care team.

You will conduct comprehensive assessments, coordinate resources, educate patients on care options including end‑of‑life planning, document interventions, and partner with Community Health Workers to address complex needs.