The Clinical Medical Social Worker assesses the psychosocial needs of beneficiaries and provides solution-focused care coordination. They ensure compliance with health plan requirements and advocate for beneficiaries throughout the care continuum.
Requirements summary
Candidates must have a Master’s Degree in Social Work and at least 3 years of experience in a healthcare environment. Proficiency in MS Office and strong crisis intervention skills are also required.
The primary role of the Social Worker is to assess the psychosocial needs of beneficiaries and provide solution-focused care coordination to address issues that impede their ability to adhere to their healthcare treatment plan. The Social Worker identifies, evaluates, and provides management of services for beneficiaries with complex, catastrophic, SDOH (Social Determinants of Health) and/or psychosocial issues to promote quality, effective outcomes throughout the care continuum. The Social Worker ensures compliance with state and federal health plan requirements, Medicare guidelines and standards, and acts as a liaison to coordinate and collaborate care with physicians, family, and other providers while always remaining an advocate for beneficiaries, putting them at the center of care delivery.
Essential Duties and Responsibilities
Perform comprehensive evaluations and document findings in a concise/comprehensive manner that is compliant with documentation standards for the Center for Medicare and Medicaid Services (CMS)
Performs psychosocial beneficiary assessments in multiple settings to include but not limited to the beneficiary’s home, the PCP/specialists clinic, hospital, and/or skilled nursing facility as needed
Assist with implementing new clinical programs in collaboration with the VP, Director of Clinical Operations and Clinical Nurse Educator
Assist with development and creation of clinical programs specific to social determinants of health in collaboration with VP, Director of Clinical Operations and Clinical Nurse Educator
Coordinates identified needs utilizing federal, state, and local community resources, as available
Coordinates with external and internal teams to minimize obstacles and increase beneficiary and provider satisfaction
Cooperate with health care professionals to evaluate beneficiaries’ socioeconomical and physical condition and to assess client needs
Advocate for beneficiaries to resolve crises
Assess beneficiaries needs and/or care plan treatments
Interview beneficiaries to gather information about their backgrounds, needs, or progress
Intervene in crisis situations to assist beneficiaries
Evaluate effectiveness of Care Plan and make necessary adjustments
Coordinate PCP follow ups (call to help ensure they make their appointments) or set an appointment from the beneficiary’s home
Communicate directly with PCP and/or specialists regarding any problems, or therapy changes
Provide emotional and physical comfort and safety of beneficiaries, taking into consideration their rights and cultural backgrounds
Provide education, monitoring of health needs, and coordinating of community resources
Participate in case conferences, team meetings, staff meetings and Performance Improvement activities as assigned
Facilitating beneficiary empowerment and quality of life by promoting educated, independent beneficiary choice on all aspects of care
Identifying opportunities for health promotion and illness prevention
Adhere to all policies and procedures including but not limited to the HIPAA Privacy rule
Adheres to all policies and procedures including HIPAA
Maintains professional licensure and other requirements
Performs other duties as assigned
Knowledge, Skills and Abilities
Documentation Skills
EMR proficiency
Analyzing Information
Critical Thinking Skills
Decision Making
Verbal and written communication proficiency
People Skills
Conflict resolution
People Management
Integrity, compassion
Bilingual: Spanish and English
Minimum Education and Experience
Master’s degree in social work from an accredited school
3+ years of social work experience in a healthcare and/or community environment
Proficient in MS Office Suite to include Word, Excel, Notes, Outlook
Knowledge of Social Work theory and practice as it pertains to people of all ages
Knowledge of population health management engagement strategies
Knowledge of Medicare/Medicaid populations and community-based resources
Experience working with medically complex patients
Experience in crisis intervention, de-escalation, and short-term counseling
Experience addressing barriers to care, including social determinants of health (SDOH)
Job Location
Hybrid, Onsite 3 days a week. As needed in-person attendance at corporate office for meetings, events, and workshops
Local road travel required, 25–50% within Miami-Dade and Broward counties. Field visits may include patient homes, clinics, hospitals, and skilled nursing facilities
