Social Worker

Social Worker 2

[Cookevle, TN, 38506] |   2024-03-14 09:55:05

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Job Code : 2024-MY3TECH0548

Job:Social Worker 2

Job ID:  Multiple positions (62361, 62360,62364,62363,62359,62355, 62365,62366, 62367,62368,62369 each job id location is different ) 

Location : 1100 England Drive   Cookeville,  Tennessee    38501

Job Duties:

The Clinical Care Team will take referrals from primary care providers and will work with the primary care team to accomplish the following tasks:

Social support navigation for social determinants of health (SDOH) such as food insecurity, housing insecurity, etc.

o    Compile and maintain a resource list for SDOH resources including eligibility criteria, referral process, and contact information

o    Collaborate with primary care nurse and providers

o    Provide in-person or remote social needs screening/assessment with primary care patients referred by nurse or provider

o    Coordinate or make aware of social services resources, i.e., housing, clothing, food, mental health services, etc.

o    Collaborate with other social workers to identify patient and community resources

·         Conduct case management activities

o    Work with hospitals for discharge planning, follow-up and education

o    Assist with obtaining patient records from hospitals

o    Assist in securing needed medical equipment through community partners

o    Conduct follow-up on care plans

o    Identify patients lost to follow-up or overdue for care and assist them in returning to care

·         May assist with specialty referral navigation

o    Schedule, coordinate, and track non-BCS specialist and imaging referrals

o    Assist with obtaining patient records from specialists and imaging centers

o    Compile and maintain resource list for specialty referrals including eligibility criteria, referral process, cost and contact information

·         Assist patients to locate and access low-cost prescription options such as patient assistance programs, discount retailers, etc.

o    May assist with patient assistance program applications and serve as a patient-provider liaison with the drug companies

o    Assist patient with applications for programs such as CoverRx and RxOutreach

·         May help with other regional primary care-based initiatives with a social work component

·         Documents in patient’s record, updates consults, and tags provider and/or clinical staff as necessary

·         Provide patient education or find appropriate education resources

Expectations may include:

·         Complete onboarding and orientation

·         Participate in regional office and primary care clinical meetings as requested

·         Attend provider meetings as requested

·         Attend Health Councils and other community meetings to build relationships with social service agencies and promote health department services

·         Identify barriers to care or assistance experienced by our patients and seek ways to address them

Tools and Equipment:

1.     Personal Computer

2.     Telephone

3.     Fax Machine

4.     Printer

5.     Scanner

6.     Copy Machine

7.     Calculator

8.     Personal Vehicle

Other office related equipment as required