Provides comprehensive social work approach to outpatient care management for patients at-risk for poor health outcomes due to medical and social complexity.

Major Responsibilities:

• Performs culturally responsive psychosocial screening and assessment to identify social, psychological, behavioral, economic, and environmental needs of outpatients and their families. May include family needs assessment, assessment of safety and environment risk, and assessment of resource needs.
• Develops goals related to the social, psychological, behavioral, economic, and environmental needs of the patient and family, and in alignment with the patient’s overall health goals. Identifies potential risks and barriers to positive health outcomes. Identifies other necessary resources and services both within the health care system and the community which may include safety planning.
• Provides appropriate social work and therapeutic interventions to facilitate the execution of the social care plan. Includes psychosocial and supportive counseling, health behavior coaching, motivational interviewing, psychoeducation and health literacy, case management, and crisis intervention services.
• Provides education to patients and families regarding Advance Care Planning for health care decision-making and assists with the execution of those documents as necessary.
• Facilitates safe and effective transitions to home and community. Facilitates smooth handoffs to other professional and community support providers. Assists with problem-solving and resolution of barriers to access to care. Incorporates systemic and solution-focused approach to case management and care coordination.
• Serves as integral member of health care team supporting team-based approach to care management. Provides effective communication and collaboration with team members.
• Provides patient navigation and advocacy services. Participates in outpatient care management initiatives as well as strategies aimed at enhancing the patient experience and improving clinic and department quality.
• Participates in research activities. Adheres to evidence-based and industry best practices for professional social work. Adheres to the social work professional code of ethics and demonstrates decision-making based on ethical principles. Documents social work activities in accordance with department protocols and standards and in keeping with all relevant federal and state regulations.
• Provides strength-based, social work services to diverse patient populations using a cultural humility framework and grounded in principles of trauma-informed care.
• Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration, and/or Certification Required:

• Social Worker license issued by the state of Wisconsin.

Education Required:

• Master's Degree in Social Work.

Experience Required:

• Typically requires 1 year of experience in providing social work services within a complex care system.

Knowledge, Skills & Abilities Required:

• Demonstrated knowledge of social work principles and methods, and the ability to apply these in a health care setting.
• Demonstrated decision-making, team building, time management, customer service, and conflict resolution skills.
• Excellent oral and written communication skills.
• Intermediate computer skills including word processing, presentation applications and electronic mail.
• Demonstrated organization and time management skills.
• Ability to work with a multidisciplinary team.

Job Type: Part-time

Pay: $58,000.00 - $87,000.00 per year

Expected hours: 24 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Patient demographics:

• Adults
• Older adults

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

License/Certification:

• Social Work License (Required)

Ability to Relocate:

• Kenosha, WI 53142: Relocate before starting work (Required)

Work Location: In person