Social Worker

• Incorporates knowledge of community resources and entitlement programs in planning, knows how to make appropriate referrals to community and other governmental agencies for services, and demonstrates ability to coordinate services.
• Must be able to independently assess the psychosocial functioning and needs of members to formulate and implement a treatment plan, identifying the member’s problems, strengths, weaknesses, coping skills, and connect them with additional services/resources, as appropriate.
• Must be proficient in motivational interviewing to assess and encourage change.
• Must work from a strength based, member centered perspective to independently conduct psychosocial assessments and provide psychosocial treatment to a wide variety of individuals from various socio-economic, cultural, ethnic, educational and other diverse backgrounds for our care coordination programs (behavioral health case management, episodic social work and episodic behavioral health care management).
• Takes ownership of each member contact to anticipate member needs, resolve their issues and connect them with additional services/resources, as appropriate.
• Must have knowledge and experience in the use of medical and behavioral health diagnoses, psychiatric medications and treatment procedures.
• Conducts behavioral health utilization management in accordance to MCG and ASAM criteria, participates in discharge planning, and encourages enrollment in behavioral health case management.
• Coordinates discharge planning activities with an interdisciplinary team
• Actively participates in SNP (Special Needs Population) rounds, interdisciplinary inpatient and skilled nursing facility rounds.
• Interacts with hospital discharge planning team (i.e. hospital social workers, case managers, and Case management staff) for the collection of pertinent information for timely discharge planning and linkage to appropriate community resources.
• Demonstrate an understanding about the SDOH and/or psychosocial needs of members and the impact of SDOH and/or psychosocial problems on the member’s well-being and compliance with treatment.
• Interacts with medical directors to discuss member’s treatment plans.
• Conducts assessments with high risk members with chronic conditions (i.e. ESRD on HD, severe diabetes, etc.) to assess barriers to receiving care and provide assistance.
• Acts as a bridge between HCP and doctor offices to increase awareness of the SW and BH department and how social workers can assist them in managing their patient’s behavioral health and social needs; conducts PCP office visits as appropriate.
• Must have knowledge and skill in the use of computer software applications for drafting documents, data management, and tracking.
• Provides crisis intervention and stabilization as needed. May require some after hours and/or weekend follow-up for emergency situations.
• Demonstrates excellent interpersonal skills and works well in a team
• Demonstrates active listening skills and proficient documentation skills
• Completes assigned training and webinars in a timely manner.
• Identifies departmental program needs and makes recommendations.
• Participates in special projects as assigned.

• Interpersonal skills diverse groups
• Ability to efficiently problem solve
• Excellent organizational skills
• Ability to work independently as well as a team member
• Knowledge of community and governmental agencies
• Knowledge of clinical diagnosis and treatment modalities

• NYS license – Master/Clinical Social Worker
• MSW required

• 2-3 years of case management and/or hospital discharge planning

Department: Clinical Services
This is a non-management position
This is a full time position