Medical Social Worker

Description

Company : Oak Street Health

Title : Medical Social Worker, Complex Care Team

Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities.

By providing holistic, comprehensive and integrated care right in our patientsâ communities, we can help keep them healthy and reinvest cost savings in further care for those same communities and others.

Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people across the nation. With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about our mission to rebuild healthcare as it should be.

For more information, visit .

Role Description :

Oak Street Health delivers high-quality primary care to Medicare patients in neighborhood centers - and beyond, when needed.

The Home Visit Social Worker is a member of Oak Street Healthâ s Home Visit care team and supports a panel of high-risk, high-need patients.

This role partners with Transitions RNs, House Calls Nurse Practitioners and Medical Assistants, Palliative Care, as well as clinic-based primary care teams.

The Social Worker is responsible to co-manage a panel of patients, with services delivered both in home and by phone. This role reports to the Home Visit Mobile Practice Manager and has oversight by a Lead MSW in the region.

Core Responsibilities :

Identify and address psychosocial and environmental barriers impacting patientsâ health, including SDOH

Provide effective and reliable support to patients and caregivers in the home and by phone

Facilitate goals of care / Advanced Care Planning conversations

Manage referrals for patients to community-based agencies and resources

Document assessments and interventions according to defined protocols, with attention to role-specific and team-wide metrics

What are we looking for?

Masterâ s in Social Work required, preferably from a school of social work accredited by the Council on Social Work Education

Licensed Clinical Social Worker

Minimum one year of clinical social work experience

Prior independent care management or case coordination experience

Comfort working in various settings, including in patientâ s homes

Skilled collaborator who thrives in a team environment

Access to reliable transportation

Flexibility to travel around predetermined region

Bilingual (English and Spanish)

US work authorization

Someone who embodies being â Oakyâ

What does being â Oakyâ look like?

Radiating positive energy

Assuming good intentions

Creating an unmatched patient experience

Driving clinical excellence

Taking ownership and delivering results

Being scrappy

Why Oak Street?

Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as :

Collaborative and energetic culture

Fast-paced and innovative environment

Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits