Description

A Licensed Social Worker is a professional who helps individuals and families improve their quality of life by ensuring access to basic needs such as food, shelter, and safety. The social worker works in partnership with their patients and families to achieve better lives by analyzing the environment, relationships, systems, and policies that impact their patients' lives. Common challenges that social workers must help their patients overcome include poverty, unemployment, mental illness, addiction, and trauma. Social workers work with patients and build relationships based on trust and compassion. They identify the barriers their patients are facing and propose resources according to their needs.

Our Health Home program help those that need help managing chronic conditions, care coordination, care transitions and follow ups, individual and family support with medical and social needs.

Essential Duties and Responsibilities:

• Administer clinical rounds in which Community Health Navigators (CHN’s) will present Care Plans for high-risk members for feedback on both clinical and social topics
• Create and conduct training sessions on a variety of topics to coach and teach community health navigators. Topics include but are not limited to diabetes, COPD, food insecurity and education.
• Conduct one on one counseling with high-risk members when an escalation event occurs with a CHN who needs additional guidance or support.
• Counsel CHNs and/or members on how to create SMART goals with achievable interventions
• Counsel CHNs on how to overcome barriers and objections when implementing SMART goals.
• Support members and CHNs in times of escalation for mental health and/or substance abuse needs
• Evaluate member treatment plans on an ongoing basis when necessary

Train CHNs for onboarding

• clinical rounds - approve care plans (many chronic conditions & social needs) & individualized housing plans (
• 1 off trainings on specific refreshers & educational aids, i.e. how to find housing resources, benefits offered by Medi-Cal, how to speak with members with SMI or SUD, motivational interviewing, etc.
• 20% travel for in-person trainings/meetings.

Qualifications

Candidate Must Possess the Following:

• A valid driver's license
• Access to an insured car
• Covid Vaccine Verification

Education & Work Experience:

• Minimum of 2 years’ experience working in health, social, or community services required
• State-based certification LCSW

Skills Required:

• Knowledge of community resources within the community to be served
• Able to maintain clear professional boundaries with members and coworkers
• Working knowledge of social and health issues
• Ability to quickly establish trust and build strong relationships
• Highly organized and self-motivated to work independently and manage schedules efficiently
• Sound judgment and the ability to quickly analyze situations
• Ability to establish priorities and meet deadlines
• Ability to problem solve in a proactive, creative manner
• Ability to work independently within a virtual operating environment and as part of a team
• Represent the company with professionalism
• Cultural competency- able to work with diverse groups of community members
• Multi-lingual capabilities preferred, but not required
• Excellent communication skills
• Technologically knowledgeable or experienced in note entry systems, smart phones, and laptops