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 patients’ 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 www.oakstreethealth.com.

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 Health’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 patients’ health, including SDOHProvide effective and reliable support to patients and caregivers in the home and by phoneFacilitate goals of care / Advanced Care Planning conversationsManage 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?

Master’s in Social Work required, preferably from a school of social work accredited by the Council on Social Work Education Licensed Clinical Social WorkerMinimum one year of clinical social work experiencePrior independent care management or case coordination experienceComfort working in various settings, including in patient’s homesSkilled collaborator who thrives in a team environment Access to reliable transportationFlexibility to travel around predetermined regionBilingual (English and Spanish) US work authorizationSomeone who embodies being “Oaky”

What does being “Oaky” look like?

Radiating positive energyAssuming good intentionsCreating an unmatched patient experienceDriving clinical excellenceTaking ownership and delivering resultsBeing 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 cultureFast-paced and innovative environmentCompetitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.