The Clinical Care Team will take referrals from primary care providers and will work with the primary care team to accomplish the following tasks:
Social support navigation for social determinants of health such as food insecurity, housing insecurity, etc.
o Compile and maintain a resource list for resources including eligibility criteria, referral process, and contact information.
o Collaborate with primary care nurse and providers.
o Provide in-person or remote social needs screening/assessment with primary care patients referred by nurse or provider.
o Coordinate or make aware of social services resources, i.
e.
, housing, clothing, food, mental health services, etc.
o Collaborate with other social workers to identify patient and community resources
· Conduct case management activities
o Work with hospitals for discharge planning, follow-up and education
o Assist with obtaining patient records from hospitals
o Assist in securing needed medical equipment through community partners
o Conduct follow-up on care plans
o Identify patients lost to follow-up or overdue for care and assist them in returning to care
· May assist with specialty referral navigation
o Schedule, coordinate, and track non-BCS specialist and imaging referrals
o Assist with obtaining patient records from specialists and imaging centers
o Compile and maintain resource list for specialty referrals including eligibility criteria, referral process, cost and contact information
· Assist patients to locate and access low-cost prescription options such as patient assistance programs, discount retailers, etc.
o May assist with patient assistance program applications and serve as a patient-provider liaison with the drug companies
o Assist patient with applications for programs such as CoverRx and RxOutreach
· May help with other regional primary care-based initiatives with a social work component
· Documents in patient’s record, updates consults, and tags provider and/or clinical staff as necessary
· Provide patient education or find appropriate education resources
Job Type: Contract
Salary: $25.
00 - $27.
00 per hour
Expected hours: 40 per week
Benefits:
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Medical specialties:
* Home Health
* Primary Care
Schedule:
* 8 hour shift
* Day shift
* Monday to Friday
Work setting:
* Community health center
* In-person
Experience:
* Social work: 3 years (Preferred)
* Clinical management: 2 years (Preferred)
Ability to Commute:
* Elizabethton, TN 37643 (Required)
Work Location: In person