Under the direct supervision of the Social Services Manager and Social Services Supervisor, the Social Worker will provide SYHealth patients with support, advocacy, development and monitoring of caseload to ensure the health, safety, and well-being of vulnerable and high-risk populations.
Essential Functions of the Job:
1.Responsible for proactive case management with the objective of improving health outcomes and providing social service support to all SYHealth patients.
2.Provide patients and families with face to face psychosocial assessments, interventions, support, advocacy, and case management.
3.Perform in-depth screening for internal and external community programs for the purpose of educating, navigating and connecting patients with needed services.
4.Obtain written authorization from patients and create patient profile on the Community Information Exchange (CIE) system.
5.Use active listening and conversational intent in all interactions to provide high quality confidential connections to resources and services to all SYHealth patients.
6.Using needs assessment, identify programs and resources to assist patients based on the social determinants of health utilizing the PRAPARE Tool.
7.Actively listen to clients to develop a strategy that identifies solutions to barriers to access.
8.Develop and implement case management plan in collaboration with the patient, caregiver, physician and/or other appropriate healthcare professionals and patient's support network to address their needs and goals.
9.Maintains ongoing patient case load for ongoing continuity of care.
10. Assesse for barriers to care, provide care coordination and assistance to patients to address concerns.
11. Maintains a working knowledge of facility service areas including transportation, community characteristics, and geography.
12. Accurately document all patient interactions and unmet needs into NextGen to assist in the identification of gaps in services that can be addressed organizationally
13. Comply with Community Information Exchange regulations and complete all CIE trainings.
14. Conduct weekly and reflective supervision with First 5 First Steps Case Managers for professional growth and support.
15. Support Case Managers with any concerns and challenges they may face in working in overburdened communities to avoid burnout.
16. Coordinate closely with other management staff to ensure appropriate referrals for program clients to other agency and partner programs.
17. Complete data entry and other required program documentation in a timely manner and oversee Case Managers documentation for accuracy and thoroughness.
18. Participate in staff training, including identification of training needs and coordination of training opportunities for project staff.
19. Ensure staff is implementing Healthy Families America evidence-based model with fidelity.
20. Keep all activities in line with the core values and contribute to the positive culture of SYHealth.
21. Maintains accurate records of all activities performed and submits pertinent reports by due dates.
22. Represent SYHealth in an effective and professional manner and maintains positive working relationships with the general public, clients, patients, co-workers and other agencies.
23. Adheres to SYHealth and all department's policies and procedure protocols.
Education Required (Minimum level of education):
Bachelor's Degree in Social Work or Psychology.
CA drivers license with appropriate insurance coverage
Experience Required (Minimum level of experience):
Experience as Clinical Social Worker; one year in clinical
Healthcare setting and administrative experience. Experience in home visitation with a strong background in primary prevention services to the 0 to 3 age population.
Verbal and Written Skills Required to perform the Job:
Bilingual (English and Spanish). Good written and verbal communication.
Working Traits: Superb organizational ability and exceptionally analytical.
Technical Knowledge and Skills Required to Perform the Job:
Knowledge of community resources and their use to meet the needs of families. Has organization and project management skills.
Ability to establish and maintain good interpersonal relationships. Ability to work independently and meet deadlines.
Equipment Used: Personal Computer
Long Irregular hours. May work weekends.
Prolonged periods of sitting, and constant walking and standing. Driving and occasional travel required.
San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family.
The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 92,000 patients through a vast and integrated network of 34 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees.
Apply today and become a part of our mission-driven team!
San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to reace, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
San Ysidro Health Center