Job Description 

The Social Worker is an ideal position for a proactive, self-motivated, positive individual who will work closely with the interprofessional care team to coordinate patient care and improve patient outcomes. The Social Worker will interface directly with a panel of patients with a focus on supportive services appropriate for the patient as well as providing short term-based Screening, Brief Intervention and Referral (SBIRT) services. 

Duties and Responsibilities 

• Collaborate with the core functional care team to provide psychosocial interventions and case management services to a patient panel. 

• Interact with and evaluate patients in the home, via teleconference, or via telephone as appropriate. 

• Identify and manage patients’ psycho-social conditions and obstacles to care. 

• Determine the need for community-based organizations and resources as appropriate.

• Collaborate with health plan behavioral services, social services agencies, mental health providers, and other community agencies on behalf of patients. 

• Educate patients and care team members about available social and mental health services. 

• Determine the need for community-based organizations and resources as appropriate. 

• Develop and implement comprehensive care plans for the patient panel. 

• Document all medical encounters accurately and in a timely manner. 

• Assist in the development and implementation of clinical protocols and guidelines of care in order to optimize outcomes. 

• Support company efforts of continuous quality improvement. 

• Adhere to all company policies and procedures. 

Requirements 

• A master’s degree in social work (MSW) or Licensed Clinical Social Worker (LCSW) in the state of Florida. 

• High level of clinical and case management expertise. 

• Must meet Duo Health requirements for care team staff, including passing a background check and drug screen and meeting COVID-19 vaccine requirements. 

• Reliable transportation, drivers license and a verifiable good driving record. Must be able to work from home, and able to travel to patient homes. 

• Must be self-motivated and able to perform work in accordance with defined operating procedures. 

• Ability to develop and maintain inclusive and equitable relationships with patients, caregivers and staff 

• Experience working with community resources from diverse backgrounds

• Priority will be given to candidates who live in the communities we serve and whose life experience reflects that of our patient population 

• Ability to communicate effectively both orally and in writing.

• Must be comfortable interacting with patients and care teams both telephonically and in-person.