Licensed Clinical Social Worker (LCSW) - Full Time, Days

Licensed Clinical Social Workers plays a crucial role in identifying and addressing the biopsychosocial needs of members with highly complex medical and mental health conditions and creating a viable treatment plan to move members towards optimal physical and mental health. Armed with a graduate degree and clinical licensure that prioritizes prevention and empowers the member’s self-management, along with high levels of compassion and strong interpersonal skills; LCSW’s help members better navigate medical, behavioral health, and social service systems to meet their needs.

The CRC Licensed Clinical Social Worker (LCSW) will provide support to the outpatient dual-risk capitated members accessing SCHS and Alta Hospitals. The LCSW will provide community resources and coordinate resources as indicated, collaborating directly with primary care offices, MSO’s, CRC and hospital care management, specialty/hospital-based physicians, and others.

The LCSW will: advocate for patients; empower patients to become effective advocates for their own needs and the needs of their families; identify and support patients overcoming obstacles related to treatment plans and other medical, social, and/or behavioral health services; help patients secure necessary and appropriate medical, social, and/or behavioral health services.

The LCSW is responsible, along with other members of the Medical Management Team, for contributing to the clinical, quality, financial, and member satisfaction outcomes.

• Provide on-demand integrated care consultations to a diverse member population in collaboration with the Coordinated Regional Care (CRC) Team and the medical team. Consultations to be provided from a biopsychosocial-spiritual framework. Services include screenings, support, brief interventions, and referrals as deemed appropriate.
• Provide psychoeducational information as appropriate for members and/or family members or accompanying caregiver and act as an advocate for members' care needs by identifying and addressing gaps in care and refer for traditional counseling services and support to members as indicated
• Collaborate with member’s behavioral health, medical team and/or the Psychiatric Mental Health Nurse Practitioner (PMHNP) for more intense case management related those members who are diagnosed with chronic mental illness and/or substance abuse related disorders and offer support to the PMHNP as requested. 
• Provide education and training to staff as identified and including, but not limited to: Advance Directive, POLST, Mental Health and Probate Dementia Conservatorship, hospice and palliative Care. 
• Serves as an accountable member of the care team to oversee appropriate rendering of services (e.g., during transitions in care or transition to home care, back up plans, community-based services) including education to providers, support staff, members and families regarding care management role and health strategies with a focus on member-focused approach to care.
• Participate in outreach educational activities in the community and in all meetings and trainings as assigned 
• Remain current and knowledgeable about local and regional resources identified during SDOH assessments and assists the member in addressing the following: Health-Related Social Needs/ Social Determinants of Health HRSN/SDOH Include: housing insecurity/homelessness, substandard housing conditions, food/nutrition, transportation, utilities, exposure to violence, social isolation, language/communication barriers, cultural isolation, parenting/educational skills, elder care, parent-child conflict, family relations issues, recreational activities, and more. Health, Behavioral Health, Substance Use: Includes: assisting with medical appointments (scheduling, confirmation, reminders, transportation, follow-up), effective engagement with primary care, medical assistance, insurance enhancements, prescriptions, medical equipment, dental care, chronic condition management including health education/prevention, barriers to treatment-plan- compliance including medication adherence, facilitating services to address BH/SUD needs of patient and/or family members across all levels of need (mild/moderate/severe) from treatment to recovery. 
• Works under the direction of the Clinical Leadership including: Medical Director and Director of Care Management in coordination with CRC management, hospital care management, hospital social work, Primary Care Physician (PCP) staff, PMH-NP , and other care coordination staff to determine plan-of-care management, coordinate and complete care plan-related activities, and meet the medical, social, and/or behavioral health needs of attributed patients.
• Attends relevant training as necessary to maintain professional certification and/or knowledge and completes other duties as assigned within the scope of position expectations.

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