Community Health Worker

Description

Company: Oak Street Health

Title: Medical Social Worker

Location:

Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated care right in our patients' communities, we can help keep them healthy and reinvest cost savings in further care for those same communities and others. Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people across the nation. With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about our mission to rebuild healthcare as it should be.

For more information, visit www.oakstreethealth.com.

Role Description:

The Medical Social Worker is a key member of a clinic, contributing to multiple care teams to support the social service needs of our patients. In partnership with the care team, they will serve as a prevention specialist, providing assessment, advocacy, and case management services to individual patients and their caregivers, in an effort to help patients maintain or improve their health status and avoid hospitalizations.

Core Responsibilities:

• Proactively support our highest need patients through telephonic check-ins, clinic visits, and home visits (with and without a clinician)
• Partner with patients to identify their goals, increase engagement in care and reduce barriers to achieving healthcare goals and execution of their care plan
• Facilitate patient referrals to community agencies and resources, under direction of the provider and in line with Oak Street Health medical management efforts
• Navigate Managed Care plans and resources to ensure mindful utilization
• Provide community case management to increase patient ability to independently manage health conditions and reduce reliance on support services
• Increase patient understanding of end-of-life options and prepare patients and their caregivers for potential challenges in end-of-life care
• Lead patient and caregiver support groups focused on specific topics such as living with chronic illness, disease-specific education, aging with dignity, caregiver coaching, etc.
• Participate in care team meetings, leading discussion around patients in his/her caseload
• Complete case and progress documentation in a timely manner to allow for visibility into case status and productivity

What are we looking for?

• Motivated social workers with a problem-solving orientation and a flexible and positive attitude
• Prior independent care management or case coordination experience
• Experience conducting home visits and providing telephonic support
• Enthusiasm for working with adults with disabilities, older adults, and adults with severe and persistent mental illness
• Experience working on a multidisciplinary team preferred
• US work authorization
• Someone who embodies being 'Oaky'

What does being 'Oaky' look like?

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being scrappy

Why Oak Street?

Oak Street Health offers our coworkers the opportunity to be at the forefront of a revolution in healthcare, as well as:

• Collaborative and energetic culture
• Fast-paced and innovative environment
• Competitive benefits including paid vacation and sick time, generous 401K match with immediate vesting, and health benefits

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply to oakstreethealth.com/careers.