Social Worker/Integrated Behavioral Health Clinician

Community Health Systems, Inc.; Beloit (WI); On-site; USD 65,000 - 85,000; Full time

Job summary

Community Health Systems, Inc. is seeking a Licensed Clinical Social Worker (LCSW) integrated behavioral health clinician to provide behavioral health services, social work support, and care coordination within a primary care setting.

You address social determinants of health, preventive care, and barriers to accessing services, collaborating with medical teams to improve access and outcomes. The role may support OB care coordination and Well Woman Program activities, with trauma-informed and

Qualifications

• Master’s degree in social work is required.
• Wisconsin LCSW or APSW credential required.
• Minimum 2–4 years of clinical experience, ideally in primary care or integrated behavioral health.
• Experience with behavioral health assessment, brief intervention, crisis management, and care coordination.

Responsibilities

• Provide integrated behavioral health services within the primary care setting, including assessment and brief intervention.
• Conduct screenings and develop short-term treatment plans within licensure scope.
• Provide crisis intervention, safety planning, and risk assessment as needed.
• Address social determinants of health, linking to community resources.
• Coordinate care across medical, behavioral health, social services, and community systems.
• Facilitate referrals to specialty mental health, substance use treatment, and community programs.
• Perform warm handoffs with medical providers and participate in team-based care.
• Support Well Woman Program and WISEWOMAN outreach, education, and preventive care coordination.
• Assist with OB care coordination, including prenatal/postpartum resources when applicable.
• Document encounters timely in electronic health records and required systems.
• Promote engagement, adherence to care plans, and improved health outcomes.
• Maintain confidentiality and comply with standards.
• Participate in team meetings, case conferences, and care coordination activities.

Skills

Communication

Organization

Documentation

EHR Proficiency

Team Collaboration

Independent Work

Patient-Centered Care

Education

Master’s degree in social work

Wisconsin LCSW or APSW credential

Job description

Job Summary

The Licensed Clinical Social Worker (LCSW) / Integrated Behavioral Health Clinician provides behavioral health services, clinical social work support, and care coordination within the primary care setting. This role supports whole‑person, patient‑centered care by addressing behavioral health conditions, social determinants of health (SDOH), preventive care needs, and barriers to accessing medical and community services. The clinician functions as an embedded member of the care team, working closely with medical providers, nursing, behavioral health staff, care coordination, referral staff, and community partners to improve access, engagement, follow‑through, and health outcomes. Services include behavioral health assessment, brief intervention, short‑term therapeutic support, crisis support, care coordination, and linkage to community resources.

This role includes active support of Wisconsin Well Woman Program and WISEWOMAN services, including patient outreach, education, follow‑up, coordination of preventive care, cardiovascular risk reduction services, healthy behavior support services, and required program tracking. The position may also support obstetric (OB) care coordination depending on clinic workflow and staffing needs. Services are delivered in a trauma‑informed, culturally responsive, ethical, and patient‑centered manner consistent with organizational policies, regulatory standards, professional scope of practice, and grant requirements.

Essential Job Functions

• Provide integrated behavioral health services within the primary care setting, including assessment, brief intervention, short‑term therapeutic support, and follow‑up.
• Conduct behavioral health screenings and assessments; develop and implement short‑term treatment plans within the scope of LCSW licensure and clinic workflow.
• Provide crisis intervention, safety planning, and risk assessment as clinically indicated.
• Identify and address social determinants of health through screening, assessment, care planning, and connection to appropriate community resources.
• Coordinate care across medical, behavioral health, social service, and community systems to support patient needs and continuity of care.
• Facilitate referrals and linkage to specialty mental health, substance use treatment, social services, and community‑based programs when needs exceed the scope of brief integrated care.
• Perform warm handoffs with medical providers and participate in team‑based care, case collaboration, and interdisciplinary care planning.
• Support Well Woman Program and WISEWOMAN services, including outreach, education, follow‑up, coordination of preventive care, lifestyle intervention referrals, and cardiovascular risk reduction support.
• Assist with WISEWOMAN‑related tracking, data collection, reporting, grant requirements, and quality improvement activities as required.
• Provide care coordination support for OB patients as applicable, including linkage to prenatal care, postpartum care, WIC, transportation, insurance resources, behavioral health services, and other supportive services.
• Document all patient encounters and care coordination activities accurately and timely in the electronic health record and other required systems.
• Promote patient engagement, adherence to care plans, preventive care completion, and improved health outcomes.
• Maintain confidentiality and comply with all legal, ethical, professional, and organizational standards.
• Participate in team meetings, case conferences, huddles, program meetings, and care coordination activities.
• Provide culturally responsive, trauma‑informed care to diverse patient populations.
• Perform other related duties as assigned.

Preferred Qualifications

Skills / Abilities

• Strong communication, organizational, follow‑up, and documentation skills.
• Proficiency in electronic health record documentation.
• Ability to work independently and as part of an interdisciplinary team in a fast‑paced environment.
• Commitment to mission‑driven, patient‑centered care.

Education

• Master’s degree in social work required.
• Current, unrestricted Wisconsin Licensed Clinical Social Worker (LCSW) credential or Advance Practice Social Worker (APSW) required.

Related Work Experience

• Minimum of 2–4 years of clinical experience preferred, ideally in primary care, integrated behavioral health, FQHC, community health, outpatient behavioral health, maternal‑child health, or care coordination.
• Experience with behavioral health assessment, brief intervention, crisis management, safety planning, motivational interviewing, and short‑term therapeutic support.
• Experience supporting patients with mild to moderate behavioral health needs, including depression, anxiety, adjustment concerns, grief, stress, trauma‑related concerns, substance use concerns, and chronic disease coping.
• Experience addressing social determinants of health, including housing instability, food insecurity, transportation barriers, financial strain, interpersonal violence, and access to care.
• Knowledge of community resources including Medicaid, housing supports, food assistance, transportation services, behavioral health services, substance use treatment, WIC, prenatal resources, and other local supports preferred.
• Experience with women’s health, preventive screening programs, WISEWOMAN, Well Woman Program, OB care coordination, chronic disease prevention, or population health initiatives preferred.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to sit; talk or hear and has substantial movements of the wrists, hands, and/or fingers.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is frequently exposed to significant work pace/pressure. The work environment is usually moderate.

Lines of Supervision

DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by people assigned to this job class. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

COMMUNITY HEALTH SYSTEMS, INC. IS AN EQUAL OPPORTUNITY EMPLOYER