Social Worker 2

Nleague Services Inc.; Elizabethton (TN); On-site; USD 42,000 - 65,000; Full time

Job summary

Social Worker 2 position at TN DOH in Elizabethton, TN, onsite from 8:00 AM to 4:30 PM. Duration: 6+ months.

The role involves social support navigation for SDOH, coordinating resources, case management, discharge planning, and collaboration with primary care teams to improve patient outcomes and access to services.

Responsibilities

• Social support navigation for social determinants of health (SDOH) such as food and housing insecurity.
• Compile and maintain a resource list for SDOH resources with eligibility criteria, referral process, and contact information.
• Collaborate with primary care nurses and providers to coordinate care and referrals.
• Provide in-person or remote social needs screening/assessment for primary care patients.
• Coordinate social services resources including housing, clothing, food, and mental health services.
• Conduct case management activities and follow up on care plans.
• Work with hospitals for discharge planning, follow-up and education.
• Assist in securing medical equipment through community partners and obtaining patient records.
• Identify patients lost to follow-up and assist them in returning to care.
• Schedule and track non-BCS referrals and assist with patient assistance program applications.

Tools

Personal Computer

Telephone

Fax Machine

Printer

Scanner

Copy Machine

Calculator

Personal Vehicle

Job description

Job ID: 66500

Position : Social Worker 2

Location: 403 E G Street Elizabethton, Tennessee 37643

Duration: 6+ Months

Client: TN DOH

Shift: 8:00 AM to 4:30 PM (onsite)

Job Duties

• The Clinical Care Team will take referrals from primary care providers and will work with the primary care team to accomplish the following tasks:
• Social support navigation for social determinants of health (SDOH) such as food insecurity, housing insecurity, etc.
• Compile and maintain a resource list for SDOH resources including eligibility criteria, referral process, and contact information
• Collaborate with primary care nurse and providers
• Provide in-person or remote social needs screening/assessment with primary care patients referred by nurse or provider
• Coordinate or make aware of social services resources, i.e., housing, clothing, food, mental health services, etc.
• Collaborate with other social workers to identify patient and community resources
• Conduct case management activities
• Work with hospitals for discharge planning, follow-up and education
• Assist with obtaining patient records from hospitals
• Assist in securing needed medical equipment through community partners
• Conduct follow-up on care plans
• Identify patients lost to follow-up or overdue for care and assist them in returning to care
• May assist with specialty referral navigation
• Schedule, coordinate, and track non-BCS specialist and imaging referrals
• Assist with obtaining patient records from specialists and imaging centers
• Compile and maintain resource list for specialty referrals including eligibility criteria, referral process, cost and contact information
• Assist patients to locate and access low-cost prescription options such as patient assistance programs, discount retailers, etc.
• May assist with patient assistance program applications and serve as a patient-provider liaison with the drug companies
• Assist patient with applications for programs such as CoverRx and RxOutreach
• May help with other regional primary care-based initiatives with a social work component
• Documents in patient's record, updates consults, and tags provider and/or clinical staff as necessary
• Provide patient education or find appropriate education resources

Expectations May Include

• Complete onboarding and orientation
• Participate in regional office and primary care clinical meetings as requested
• Attend provider meetings as requested
• Attend Health Councils and other community meetings to build relationships with social service agencies and promote health department services
• Identify barriers to care or assistance experienced by our patients and seek ways to address them

Tools And Equipment

• Personal Computer
• Telephone
• Fax Machine
• Printer
• Scanner
• Copy Machine
• Calculator
• Personal Vehicle