Job Category:

Behavioral Health, Counseling, and Clergy

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The primary responsibilities for the Social Worker within the Care Management team include providing social work services to patients receiving care primarily in the primary care setting. In collaboration with Primary Care Physician, members of the health care team, the patient and their caregivers/families, the Social Worker will assess the social, psychological, cultural, environmental and financial factors unique to the individual. From this assessment, the Social Worker will assist in the development and implementation of a plan to address non-medical factors identified as having an impact on the patient's ability to achieve goals for optimal health. The Social Worker will evaluate effectiveness of plan and work with patients and caregivers/families to implement changes where needed. The Social Worker will use crisis intervention techniques, problem solving models, community organization and patient advocacy skills in identifying needs and resources within the community.

This role will primarily support cardiac patients served by the Georgia Heart Institute (GHI) with a strong emphasis on addressing Social Drivers of Health (SDOH). The Social Worker will provide education, guidance, and resource coordination to patients experiencing barriers that limit their ability to access care or engage in their own optimal health.

Working as part of a collaborative interdisciplinary team—including a Pharmacist and an RN/Navigator—the Social Worker will also interact regularly with Providers and clinical staff involved in patient care. The position includes frequent in‑person support for patients and is further backed by a network of Social Workers serving other NGHS Ambulatory and Outpatient Clinics.

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: Masters Degree in Social Work from an accredited School of Social Work. 

• Minimum Experience: One (1) to three (3) years experience in a hospital, agency or institution providing related health care services.

• Other: LMSW required within one year (required for Cardiac Program Accreditation)

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience:

• Other: Bilingual in Spanish

Job Specific and Unique Knowledge, Skills and Abilities

• Demonstration of positive attitude, high energy, and strong organizational and interpersonal skills

• Able to demonstrate effective counseling skills based on the latest evidence for professional conduct and practice

• Excellent written and verbal communication skills with demonstrated ability to work effectively in both independent and team settings

• Current knowledge of state and federal programs that provide medical care and financial support to individual. Current knowledge of community resources

• Passion for working with individuals of varying cultural and socio-economic backgrounds

Essential Tasks and Responsibilities

• Use a family systems theory framework to structure assessment and identification of factors unique to the patient which represent a potential impact to optimal health and wellness.

• Develop a plan to address the prioritized, unique needs of the patient that have been identified through assessment.

• Communicate with Primary Care Physician and other members of the health care team regarding any items of critical information that will affect the established plan of care as well as to provide routine updates of patient's progress toward goals.

• Assess and assure appropriate reporting of any potential/actual abusive relationship where violence or neglect is a factor.

• Maintain current knowledge of community resources and facilitate connections between patients and resources as appropriate.

• Provide opportunities for interactions between you and the patient/groups of patients designed to promote patient engagement in self management of chronic conditions, lifestyle changes and behavior medications as well as education for coping with stress.

• Use a structured format to document within the EMR the results of your assessment,