POSITION SUMMARY:

Utilizing clinical social work techniques and theory, consults on, assesses, and intervenes with high-risk patients and their families regarding the impact/amelioration of emotional and social problems. Duties also include, but are not limited to, conducting psychosocial assessments, making a psychosocial diagnosis, planning and implementing effective treatments, evaluation, education, supervision, coaching and mentoring of the patient (client) and family members. The position consults with, collaborates and communicates with a wide range of social, governmental and legal agencies, courts, schools, clinics, other hospitals, physicians and other sources in the overall care of the patient.

Position: Clinical Social Worker - LICSW

Department: Outpatient OBGYN

Schedule: 40 Hours (Days)

8:30-5:00PM - Monday -Friday

ESSENTIAL RESPONSIBILITIES / DUTIES:

Clinical Care & Psychosocial Assessment

• Conduct comprehensive biopsychosocial assessments for high-risk OB/GYN patients (e.g., medically complex pregnancies, fetal anomalies, pregnancy loss, oncology, chronic illness, behavioral health concerns).

• Identify barriers to care related to housing instability, food insecurity, transportation, insurance, immigration status, safety, and financial hardship.

• Develop individualized care plans in collaboration with patients, families, and interdisciplinary teams.

• Provide brief short-term support for acute crisis intervention and warm hand off to IBH Clinicians.

Perinatal & High-Risk Support

• Support patients experiencing perinatal mood disorders, pregnancy loss, fetal demise, infertility challenges, and complex decision-making.

• Provide anticipatory guidance and emotional support around high-risk diagnoses and treatment planning.

• Assess and address intimate partner violence (IPV), child safety concerns, and mandated reporting needs.

Care Coordination & Resource Navigation

• Connect patients to community-based resources including housing supports, public benefits, legal/immigration assistance, WIC/SNAP, behavioral health services, and home visiting programs.

• Collaborate with outpatient clinics, primary care, behavioral health, and community partners to ensure continuity of care.

• Support insurance navigation and financial assistance processes.

Interdisciplinary Collaboration

• Participate in huddles, case conferences, and multidisciplinary planning meetings.

• Provide consultation to medical and nursing staff on psychosocial, cultural, and equity considerations impacting care.

• Advocate for patient needs within complex systems.

Documentation & Compliance

• Complete timely documentation in the electronic health record consistent with regulatory and departmental standards.

• Maintain accurate tracking of consults, interventions, and outcomes.

• Adhere to hospital, state, and federal guidelines related to confidentiality, mandated reporting, and patient rights.

Basic Needs & Social Determinants of Health (SDOH) Intervention

• Screen for and address unmet basic needs including housing instability/homelessness, food insecurity, transportation barriers, utilities insecurity, childcare needs, and financial hardship.

• Provide hands-on resource navigation, including assisting patients with applications for MassHealth/Medicaid, SNAP/WIC, emergency housing/shelter placements, rental assistance, cash benefits, and financial assistance programs.

• Coordinate access to diapers, infant supplies, formula, car seats, clothing, and other essential items through hospital and community partnerships.

• Partner with community-based organizations, shelters, legal aid, and immigrant-serving agencies to reduce barriers to care.

• Advocate for patients facing systemic barriers related to language, immigration status, or lack of insurance.

Department Expectations – Social Work Staff

Clinical Assessment & Care Planning

• Utilize the department’s psychosocial assessment tool as a guideline to assess patients and families for emotional, social, behavioral, and environmental needs.

• Identify priority issues that must be addressed during care and formulate an appropriate intervention and discharge plan.

• Initiate assessments within required timeframes:

  • Inpatient: begin within 24 hours of referral

  • Outpatient: