Social Worker
Company: Landmark Health
Location: Daly City
Posted on: January 15, 2021
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Job Description:
Do you want to make a difference in healthcare? Landmark Health
was created to transform how healthcare is delivered to the most
medically vulnerable members in our community. Our medical group
provides home-based medical care to chronically ill patients, many
of whom are frail, elderly and ill-equipped to navigate our
overwhelming healthcare system. Because many of our patients are
frail and elderly, we deliver care primarily in the comfort of
their home. Our Program is also offered to eligible patients at no
incremental financial cost to them . We are not a fee-for-service
practice; we benefit economically only if we deliver high-quality
patient outcomes and satisfaction. As a result, our clinical teams
can spend quality-time caring for a smaller number of patients,
giving all patients the space, respect, compassion and care they
deserve. Our model is finding success throughout the country; we
are now the nation''s largest risk-based, in-home medical group. At
Landmark, our interdisciplinary teams collaboratively manage our
complex patient panels. These teams are led by Physicians, Nurse
Practitioners, and Physician Assistants, with supporting care
provided by RN Nurse Care Managers, Social Workers, Pharmacists,
Behavioral Health and other employed team members. The primary role
of the Social Worker (SW) is to assess the psychosocial needs of
members and provide solution-focused care coordination to address
issues that impede their ability to adhere to their medical care
plan. The SW is an active member of the Interdisciplinary care team
(IDT). Social work services will be provided in home,
telephonically and/ or video. The Social Worker is responsible for:
* Facilitating serious illness / goals of care discussion with the
patient and family * Conducting an assessment of the patient''s and
family''s strengths and needs; this may be done in the home,
telephonically and or video * Developing collaborative care plan
goals with the patient and family and/ or caregivers and IDT
members * Connecting patient and/ or patient''s family/ caregiver
to appropriate community resources and supports * Providing
solution focused case management * Providing brief therapeutic
interventions to patient and family * Utilizing motivational
interviewing (MI) and other psychotherapeutic techniques to elicit
behavior change * Promoting patient and family self-management
strategies * Enhancing connectivity between patients and members of
the interdisciplinary team * Navigating community resources and
developing community partnerships to improve access to care and
ease of systems navigation * Master''s Degree (MSW) in Social Work
* Meet all state certification and licensing requirements * Minimum
of three (3) years of social work experience (internship not
included) * Minimum of two (2) years of social work experience in a
healthcare setting * Palliative and/or hospice care experience is
preferred * Experience in delivering home-care or field case
management is preferred * Excellent communication skills and
knowledge of accessing community resources * Possession of a valid
state driver''s license and access to an automobile In order to
work with potentially vulnerable patient populations and to keep
employees healthy while caring for patients, all patient-facing
employees of Landmark must provide evidence of the following
required immunizations/vaccinations as a condition of employment:
TB, MMR, Tdap, and Influenza. Declinations may be accommodated
based on your medical history, an allergy or religious beliefs.
Please immediately contact HR if you wish to apply for an exemption
from our vaccination requirements so that we may determine if you
qualify for an accommodation. by Jobble
Keywords: Landmark Health, Daly City , Social Worker, Healthcare , Daly City, California
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