Description

You will provide clinical social work support in a primary care setting to address social determinants of health and coordinate patient care.

This role is on-site.

Responsibilities

• Navigate social support systems for food, housing, and clothing insecurity.
• Conduct in-person or remote social needs screenings and assessments for referred patients.
• Manage case activities including hospital discharge planning, follow-up care, and medical equipment procurement.
• Coordinate specialty referrals and assist patients in accessing low-cost prescription options or assistance programs.
• Document all interactions in patient records and collaborate with primary care nurses and providers.

Required Skills

• 5+ years of experience in social work or related clinical care roles.
• Experience addressing housing, clothing, food, and mental health services needs.
• Ability to manage complex case management tasks and discharge planning.
• Proficiency in navigating patient assistance programs and specialty referral processes.
• Strong documentation skills for maintaining accurate patient records and consult updates.
• Ability to operate standard office equipment including computers, telephones, and scanners.
• Access to a personal vehicle for regional requirements.

Preferred Skills

• Experience attending Health Councils and social service agency meetings to build community relationships.

Key Skills

Education

Any Graduate