This is a fully remote position, open to applicants in Virginia.

📋 Description

• Oversee a caseload of patients who are high-risk and socially complex.

• Perform in-person and telephonic psychosocial evaluations with patients and/or their caregivers.

• Identify psychological and social determinants that pose barriers and create interventions to bridge gaps in care.

• Offer short-term counseling services as required.

• Coordinate services to ensure patients and families comprehend their treatment plans.

• Collaborate with the care team to meet quality and patient experience outcomes, including participation in High-Risk Huddles.

• Reach out to community-based services that enhance patients’ capacity to age in place.

• Create and implement shared care goals with patients and their families.

• Partner with community-based organizations to build relationships and provide resources that promote patient independence.

⛳️ Requirements

• Master’s degree in social work is required.

• Must hold a valid LCSW or LISW license depending on state regulations.

• A valid driver's license and a clean driving record are necessary.

• Proficiency in utilizing sound clinical judgment along with clear communication in both written and verbal forms.

• Above-average computer proficiency is essential.

• Capability to work independently and effectively communicate with professional staff across various disciplines and programs.

• Strong planning skills to effectively manage time, juggle multiple tasks, work within tight deadlines, resolve issues, identify patient service trends, and implement necessary system improvements.

• Ability to share knowledge with others while recognizing the importance of fostering performance improvement to achieve patient satisfaction and efficiency.