Bilingual Spanish or Mandarin Preferred Medical Social Worker (LSW)

Company: Oak Street Health 

Title: Medical Social Worker

Company Description

The mission of Oak Street Health is to rebuild healthcare as it should be. 

We are a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare.

The Oak Street model integrates outstanding clinical expertise, technology, and teamwork to deliver improved care quality and cost savings. These cost savings are then reinvested into care in our communities, creating a virtuous cycle of improving community health. 

We are a national organization serving over 100,000 patients and we are growing rapidly. We are a diverse team of care providers, service team members, technologists, community outreach experts, business professionals, and more -- all dedicated to our Oaky Values and motivated by our mission. We’re looking forward to getting to know you!

For more information, visit www.oakstreethealth.com.
 

Role Description:

The Medical Social Worker is a key member of a clinic, contributing to multiple care teams to support the social service needs of our patients. In partnership with the care team, they will serve as a prevention specialist, providing assessment, advocacy, and case management services to individual patients and their caregivers, in an effort to help patients maintain or improve their health status and avoid hospitalizations. 

Core Responsibilities:

• Proactively support our highest need patients through telephonic check-ins, clinic visits

• Partner with patients to identify their goals, increase engagement in care and reduce barriers to achieving healthcare goals and execution of their care plan 

• Facilitate patient referrals to community agencies and resources, under direction of the provider and in line with Oak Street Health medical management efforts 

• Navigate Managed Care plans and resources to ensure mindful utilization 

• Provide community case management to increase patient ability to independently manage health conditions and reduce reliance on support services 

• Increase patient understanding of end-of-life options and prepare patients and their caregivers for potential challenges in end-of-life care 

• Conduct biopsychosocial assessments using evidence-based tools for patients in care

• Participate in care team meetings, leading discussion around patients in his/her caseload  

• Complete case and progress documentation in a timely manner to allow for visibility into case status and productivity 

What are we looking for?

• Master’s degree in Social Work required, preferably from a school of social work accredited by the Council on Social Work Education 

• Minimally Licensed in the State of Practice Social Worker

• Minimum one year of clinical social work experience

• Motivated social workers with a problem-solving orientation and a flexible and positive attitude

• Prior independent care management or case coordination experience

• Experience conducting home visits and providing telephonic support 

• Experience working on a multidisciplinary team preferred 

• US work authorization

• Someone who embodies being “Oaky”

What does being “Oaky” look like?

• Radiating positive energy

• Assuming good intentions

• Creating an unmatched patient experience

• Driving clinical excellence

• Taking ownership and delivering results

• Being scrappy

<