Medical Social Worker - LMSW

Oak Street Health; Richmond (VA); On-site; USD 47,000 - 101,000; Full time

Job summary

Oak Street Health seeks a Medical Social Worker to support psychosocial needs of patients, coordinating care with the interdisciplinary team and guiding patients toward improved health outcomes and reduced hospitalizations.

The role involves assessments, advocacy, and collaboration with care teams, plus navigating insurance benefits and educating patients and families across dementia, aging, and end‑of‑life planning. Full‑time, 40 hours weekly in the US.

Qualifications

• Master of Social Work degree required from a CSWE-accredited program.
• Licensed (minimally) in the state where OSH Center is located.
• Fluency in Spanish, Polish, Russian, or other languages used by local communities.
• Proficient with computers, including Microsoft Office, GSuite, and electronic medical records.
• US work authorization.

Responsibilities

• Provide assessments, advocacy, and care coordination for high‑risk patients and caregivers.
• Perform telephonic check‑ins and in‑person visits for highest‑need patients.
• Collaborate with interdisciplinary care teams to align goals and care plans.
• Navigate insurance benefits with the Patient Relations Manager to maximize benefits.
• Deliver longitudinal and episodic care coordination to empower self‑management.
• Educate on supportive care options and goals of care counseling throughout care journey.
• Provide psychoeducation to patients and families on life stages and diseases.
• Collaborate with care teams to develop creative solutions for psychosocial challenges.
• Document concisely and comprehensively for visibility across the care team.
• Consult with Community Health Workers on complex patient needs.
• Respond to crises and urgent needs with prioritization and multitasking.
• Perform other duties as assigned.

Skills

Multilingual (Spanish/Polish/Russian)

Education

Master of Social Work degree

Tools

Microsoft Office

GSuite

Electronic Medical Records

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Title:

Company:

Role Description:

The Medical Social Worker is a key member of Oak Street Health Centers, contributing a unique and valuable perspective to care teams to support the psychosocial needs of our patients. In collaboration with the interdisciplinary care team, they will provide assessments, advocacy, and comprehensive care coordination services to our highest-risk patients and their caregivers to help them improve their health status and avoid hospitalizations.

Core 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 (if necessary) 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 Patient Relations Manager (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.

This role reports to the Practice Manager.

What we're looking for:

Required Qualifications:

• Master of Social Work degree required 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

Strongly 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

Preferred Qualifications:

• Experience working on a multidisciplinary team of other healthcare providers

Other Skills

• Motivated, experienced social workers with a problem-solving orientation and a flexible and positive attitude who are driven to improve the lives of the individuals that OSH serves.
• Passion for working with Medicare-eligible populations, including older adults, adults with disabilities, and adults with severe and persistent mental illness

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,597.00 - $101,228.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 03/30/2027

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.