BILINGUAL SOCIAL WORKER (LCSW/LMSW)

Job Opportunity

Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care. 3-4 Days of Home Visits (within 1 Hour Radius of Assigned Territory) and 1-2 Days of Telehealth Coordinating Services for the underserved population not providing direct therapy Competitive salary and bonus. Flexible paid leave and vacation policy. Laptop, mileage reimbursement, phone allowance, and extra perks available!

Responsibilities:

• Perform in-home care management visits to assess and impact social and behavioral status
• Work closely with Care Team to ensure continual progress on all care management goals
• Assess social determinants of health needs and develop a plan for addressing them
• Perform behavioral, environmental and social support assessments and surveys as needed
• Deliver individual, family and group education on living with chronic illness
• Engage family and social support groups in the education and care of patients
• Assess patients and refer to behavioral health specialists if diagnosis and treatment needed
• Help patients to understand, accept and follow medical and lifestyle recommendations
• Serve as the point of contact for patient questions regarding social and behavioral
• Facilitate conversations around and consideration of proactive care decisions, especially relating to transplantation, home modalities and AV fistula placement
• Initiate patient relationships through enrollment and onboarding processes
• Review and document patient updates and progress in care management platform
• Identify, vet and build relationships with local Community-Based Organizations
• Introduce patients to appropriate resources and act as the patient advocate
• Serve as subject matter expert on social determinants for other members of the Care Team
• Occasionally visit patients or take call remotely on some nights and weekend

Requirements:

• Master's Degree in Social Work, behavioral sciences or other related field
• Must be a Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) in the State of New Mexico
• 2+ years previous experience working in care management and/or with chronic illness within a medical environment i.e. home health, dialysis, hospice
• Ability to show empathy and quickly build relationships with patients and local CBOs
• Ability to occasionally visit patients or take call remotely on some nights and weekends
• Must be fluent in Spanish
• Excellent verbal communication skills both in person and on the phone
• Ability to work with Microsoft Office and mobile phone and web-based applications
• Self-starter with the ability to work independently with minimal supervision
• Must be a road warrior! A lot of driving involved.
• Ability to travel to company main location in Nashville for training if necessary
• Must live within 30 miles of Albuquerque