The Social Worker assesses clients' social determinants of health and connects them to essential community resources and public benefits. They collaborate with an interdisciplinary healthcare team to coordinate care and improve overall health outcomes for vulnerable populations.
Requirements summary
A Master's Degree in Social Work or a related field is required, along with fluency in Spanish. Candidates must have at least 3 years of experience in case management and social services, specifically working with homeless and low-income populations.
postgraduate degreeCase ManagementTime ManagementPatient AdvocacyInterpersonal CommunicationElectronic Health RecordsCrisis InterventionHarm ReductionMotivational InterviewingSpanish FluencyInterdisciplinary CollaborationClinical JudgmentCommunity Resource KnowledgeSocial Determinants Of Health AssessmentMulticultural CompetencyPublic Benefits NavigationProblem-Solving Interventions
Job description
PHMC's Mission is to be the premier regional provider of integrated, community-based healthcare by combining evidence-based clinical practices, outstanding client service, innovative care partnerships, and team-driven excellence, within a healthy fiscal environment.
Job Description
A Social Worker (SW) is sought to work as a part of the Integrated Health Services team at the PHMC Health Network. The Social Worker will report to the Health Network Social Services Manager and will be an integral part of the health care team, providing services to clients who come to the center for care.
The SW will meet with each new client seen by the providers to thoroughly screen and assess the client’s Social Determinants of Health and to connect the client to appropriate social service supports and resources.
The SW will provide essential information regarding community resources to clients, their families, and the health center team.
They will also work closely with the health center team to coordinate client care and to improve client health outcomes.
The MSW will also assist clients and their families in connecting to and navigating health insurance coverage and other public benefits.
Administrative duties include assessment & planning documentation, referral tracking, and service coordination and follow-up.
Social services include but are not limited to mental health and/or substance use treatment; advance directives, transportation assistance; food resources; financial counseling; education and employment assistance; and legal aid referrals.
Must be fluent in Spanish.
Essential duties and responsibilities
Assess client needs and barriers to accessing health, behavioral health, and social support services.
Assess client needs and provide referrals to appropriate social services agencies (e.g., transportation, housing, utility assistance programs, legal aid, employment assistance, etc.) and demonstrate up-to-date knowledge of community resources, especially those benefiting families and persons with low or lost income.
Facilitate communication and positive relationship building between clients and medical providers.
Incorporate strength-based assessment and brief problem-solving interventions, as appropriate, aimed at modifying negative thinking and promoting self-efficacy.
Assist clients in applying for and navigating health insurance coverage, public benefits, and exploration of entitlement programs such as social security and veteran benefits.
Interface with clients and managed care companies to facilitate Primary Care Provider (PCP) switches.
Actively participate as a member of the interdisciplinary health care team (IDT).
Collaborate with the Center of Excellence (COE) Community-Based Care Management team and Peer Recovery Program to both address psychosocial health issues and to coordinate care among providers and outside specialists.
Foster and maintain partnerships with other social service agencies.
Participate in training to become a Certified Application Counselor for the Health Insurance Marketplace and assist consumers with application and enrollment.
Participate in Social Services Team supervision, meetings, and information & skill sharing processes.
Document all services daily in the appropriate electronic health records system and other social service reporting formats.
SKILLS
Thorough knowledge of community resources, especially those that support families and individuals with low incomes, and individuals experiencing homelessness
Knowledge of Pennsylvania public benefits and DHS system (Medicaid, SNAP, TANF, etc.)
Knowledge of DSM 5 behavioral health conditions and working knowledge of chronic diseases
Strong commitment to supporting and advocating for the homeless population of cities
Ability to exercise strong clinical judgment, independent analysis, and critical thinking skills
Excellent time management skills and attention to detail to attend to caseload expectations and ensure timely documentation
Excellent ability to work and maintain flexibility in a fast-paced medical environment
Strong ability to prioritize work demands, including casework and administrative tasks
Strong interpersonal, organizational, and oral/written communication skills
Knowledge of and sensitivity to the impact of intergenerational poverty
Developed multicultural competency and desire to collaboratively work with vulnerable clients from marginalized populations
Proficiency in computer skills, including Microsoft Word, Excel, and Outlook, and willingness to learn new technology such as electronic health record systems
Ability to represent the agency and facilitate relationships with the community
EXPERIENCE Required
Experience with crisis intervention and harm reduction
Experience working with those experiencing homelessness
Experience working with families and individuals with low or no income
Experience working as a member of an interdisciplinary team
Experience with crisis intervention and harm reduction is a plus
Minimum of 3 years’ experience, working in case management and social services
Comfort with evidence-based interventions such mas otivational interviewing
Comfort working with diverse populations (i.e., race, ethnicity, diagnoses, age ranges)
Education requirement
Master’s Degree in Social Work or related.
PHMC is an Equal Opportunity and E-Verify Employer.
