Social Worker - Outpatient Clinic – Bilingual

Job Title: Social Worker - Outpatient Clinic – Bilingual

 

Social Work Services at the Mount Sinai Hospital    

The Mount Sinai Hospital is a 1,134-bed facility with an extensive outpatient and specialty care network and is the largest hospital in the Mount Sinai Health Care System. It offers comprehensive social work services and programming to meet the myriad needs of the diverse populations we serve. We believe that total patient care must emphasize the physical, emotional, and social needs of each patient and their care partners. Social Workers collaborate within interprofessional teams to serve patients and the larger community from both a micro and macro level including both direct care and prevention. Founded in 1907, the Department of Social Work Services at the Mount Sinai Hospital is one of the oldest hospital social work departments in the nation with over 450 licensed social workers employed across more than 65 different program/service areas. Employment in our department provides a pathway to LCSW licensure as well as access to a broad range of continuing education, professional development and extra-curricular opportunities.

 

Mount Sinai Health Partners (MSHP) is the management services organization developed to enhance the Health System’s implementation of population health initiatives, that is, programs of care that enhance the patient experience and health status, improve the health of patient populations and reduce utilization and healthcare costs. Population health initiatives particularly focus on preventive care. MSHP provides the infrastructure to support population health initiatives and includes services such as care coordination, information technology, workflow optimization, physician engagement and quality reporting. The Department of Social Work Services takes a leadership role in MSHP Care Management, which is providing in person and telephonic short-term and long-term care management services for a large diverse group of individuals who have a variety of insurances that are part of value based contracts.

 

The PeakHealth Clinic provides intensive medical and care coordination services to patients with multiple chronic conditions who are high utilizers of the Emergency Department and/or who have had multiple hospitalizations. It also provides short-term intensive medical management and care coordination services to patients with newly diagnosed medical conditions as well as to those who have recently been discharged from hospital or a nursing home. The Social Worker (PeakHealth Clinic) is responsible for providing assessment and intervention services to at risk patients, developing effective relationships with them and their family caregivers, and working collaboratively with the care team to improve health outcomes. 

 

The goals of MSHP Care Management in PeakHealth are: 

• to meet the challenges that present barriers to patients with multiple chronic illnesses; 
• to meet patients where they are in their readiness to change while respecting their individuality, cultural background and personal journey; and 
• to provide standardized care management services to meet patients’ medical and psychosocial needs, to increase quality of life and to reduce unnecessary health care costs.

 

This position will be based in the Center for Advanced Medicine on 102nd Street (campus of the Mount Sinai Hospital). It’s an onsite role and may include home visits.

• NYS LMSW or LCSW. 
• Exceptional skills in engaging patients/families and in assessment and coordination of resources within families and hospital and community networks for effective management of patient care.
• Exceptional organizational, collaborative and psychosocial assessment and intervention skills.
• Interest in being part of an innovative initiative to improve the quality of care by addressing barriers to behavioral health, primary and specialist care, preventable Emergency Department visits and hospital admissions/readmissions.
• Hospital experience and experience with patients with chronic behavioral health and medical conditions preferred.
• Proficiency in MS Office. Ability to learn hospital documentation and scheduling systems and care coordination applications.
• Bilingual (English/Spanish).
• Minimum one year in current position.

 

 

Non-Bargaining Unit, 096 - Social Work - ISM, Icahn School of Medicine, Care Management, Health Home

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