Social Worker

Clinical Care Team Social Worker or Social Counselor
The team member will support health department primary care clinics in the region.  The social worker or social counselor will work in their assigned clinic(s) and collaborate with clinic staff to address patient needs, meet one-on-one with patients, and identify and connect patients with community partners that offer resources to address social determinants of health (SDOH).  There will be an expectation to be at the regional office at times to participate in meetings related to clinical care and processes.  Travel within the region may be expected as needed.
Base: region-specific

Supervision: region-specific

Summary: Under general supervision, is responsible for professional social work or social counseling work and/or service coordination of average difficulty; and performs related work as required by department.
Requirements:                                             

Social Worker
Education and Experience: Graduation from an accredited college or university with a bachelor's, master's, or doctorate degree in social work and one year of full-time professional social work or social work related experience.
Substitution of Education for Experience: Qualifying graduate coursework in social work from an accredited college or university may be substituted for the required year of experience. (e.g., 36 graduate quarter hours in social work may be substituted for the one year of required experience).
OR
Possession of a Master's of Social Work Certificate (CMSW) or License of Clinical Social Work (LCSW) from the State of Tennessee
Necessary Special Qualifications: Applicants for this class must possess one or more of the following conditions at the time of appointment and must be maintained during employment in the Social Worker 2 classification as set forth in Tennessee Code Annotated, §63-23-111: 
possession of a baccalaureate or master's degree in social work from an accredited social work program approved by the Council on Social Work Education; or
possession of a doctoral or Ph.D. in social work; or
possession of a current master of social work certificate or independent practitioner of social work license as set forth in §63-23-102 and §63-23-103.
OR

Social Counselor
Education and Experience:  Graduation from an accredited college or university with a bachelor’s degree AND one year of professional experience in one or a combination of the following: health care for children, adolescent, or geriatric populations; social work; or social or psychological counseling, including, but not limited to, mental health, correctional, or behavioral rehabilitation counseling; or one year of experience in early intervention and/or service coordination with individuals with disabilities in an educational, social services or medical setting; or one year of teaching early childhood education or assessing individuals with disabilities.
Substitution of Graduate Course Work for Experience:  Additional qualifying graduate course work from an accredited college or university in a related field may be substituted for the experience, on a year-for-year basis, to a maximum of one year.
Additional Necessary Special Qualifications: Applicants for this class may be required to:
Possess a valid driver's license if driving is an essential function of the position;
Complete a criminal history disclosure form in a manner approved by the appointing authority;
Agree to release all records involving their criminal history to the appointing authority;
Supply a fingerprint sample prescribed by the TBI based criminal history records check;
Submit to a review of their status on the Department of Health’s vulnerable persons registry.  
Social Worker or Social Counselor
o   Performs tasks consistent with social work or social counseling such as refer and coordinate services, identify risk factors, assess, and address relevant patient needs such as educational, medical, psychosocial, financial as needed to assess needs of clients.

Job Duties:

The Clinical Care Team will take referrals from primary care providers and will work with the primary care team to accomplish the following tasks:
o   Social support navigation for social determinants of health (SDOH) such as food insecurity, housing insecurity, etc.

Compile and maintain a resource list for SDOH resources including eligibility criteria, referral process, and contact information
Collaborate with primary care nurse and providers
Provide in-person or remote social needs screening/assessment with primary care patients referred by nurse or provider
Coordinate or make aware of social services resources, i.e., housing, clothing, food, mental health services, etc.
Collaborate with other social workers to identify patient and community resources
o   Conduct case management activities

Work with hospitals for discharge planning, follow-up and education
Assist with obtaining patient records from hospitals
Assist in securing needed medical equipment through community partners
Conduct follow-up on care plans
Identify patients lost to follow-up or overdue for care and assist them in returning to care
o   May assist with specialty referral navigation

Schedule, coordinate, and track non-BCS specialist and imaging referrals
Assist with obtaining patient records from specialists and imaging centers
Compile and maintain resource list for specialty referrals including eligibility criteria, referral process, cost and contact information
o   Assist patients to locate and access low-cost prescription options such as patient assistance programs, discount retailers, etc.

May assist with patient assistance program applications and serve as a patient-provider liaison with the drug companies
Assist patient with applications for programs such as CoverRx and RxOutreach
o   May help with other regional primary care-based initiatives with a social work component

o   Documents in patient’s record, updates consults, and tags provider and/or clinical staff as necessary

o   Provide patient education or find appropriate education resources

Expectations may include:
o   Complete onboarding and orientation

o   Participate in regional office and primary care clinical meetings as requested

o   Attend provider meetings as requested

o   Attend Health Councils and other community meetings to build relationships with social service agencies and promote health department services

o   Identify barriers to care or assistance experienced by our patients and seek ways to address them

Tools and Equipment:
Personal Computer
Telephone
Fax Machine
Printer
Scanner
Copy Machine
Calculator
Personal Vehicle
Other office related equipment as required