Social Worker - Rural Health (Master's level, on-site + remote))

About the position St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Outpatient Care Manager, Social Worker (OP CM SW) is responsible for providing Social Work and care management services to out-patients and their families (occasional in-patients) as directed by the policies and procedures of the entity and Outpatient Care Management Department. The OP CM SW provides professionally established methods of assessing a patient's unique bio-psychosocial status, assists patients and families in resolving problem areas, and connects them with appropriate community resources and services. Responsible for the psychosocial component of patient care as it relates to medical stability and wellness, the OP CM SW collaborates with both health care and community partners to address social determinants of health and promote self-management of care needs. The OP CM SW also collaborates with the Outpatient Care Manager RN, Community Health Worker and extender staff as needed to address the social needs of the medically complex patient. Responsibilities • Provides assessment, care planning and intervention to patients and caregivers, including psychosocial and resource evaluation and planning, advocacy, as well as crisis intervention as appropriate. • Provides counseling directed toward helping patients/caregivers cope with and understand the relationship between physical functioning, illness and the consequent social/emotional impact and adjustments required. • Consults with providers, nurses and other members of the health care team to facilitate interdisciplinary care and address effective continuum of care coordination. • Investigates insurance benefits as well as community resources to provide and facilitate appropriate referrals based on patient/caregiver agreement. • Organizes individual patient care meetings with internal and, as necessary, external multidisciplinary team members and the patient/caregiver to evaluate progress and to identify and resolve problems that may interfere with a positive patient outcome. • Provides patient/caregiver and/or care team education as needed as it relates to government mandates/laws. • Proactively collaborates with patient/caregiver, care team members, and community partners as necessary to address bio-psychosocial needs to ensure efficient and effective continuity of care, utilization of resources and to avoid unnecessary hospitalizations. • Ensures appropriate clinical and patient care documentation in patient charts, completes reports and other requested/required patient documentation as needed, and maintains required statistical documentation for the department's management information system. • Functions autonomously under the Organization and Departmental policies and procedures and in compliance with the NASW Code of Ethics. • Acts as a liaison to community agencies, health institutions, etc., to address systems issues affecting patient outcomes by serving, as able, in community groups and organizations. • Demonstrates competency in the assessment, range of treatment, knowledge of growth and development and communication appropriate to the age of the patient treated. Requirements • Master's degree in Social Work from an educational institution accredited by the National Council on Social Work Education (NCSWE) preferred. • State licensure for MSW in PA and NJ preferred. • State licensure for MSW in NJ required if working in NJ. • MSW with minimum of two (2) years' experience in medical social work case management or other experience as related to site of service preferred or as above. Apply tot his job