Why Join Care at Home?

Care at Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.

Position Overview

The Licensed Clinical Social Worker (LCSW) works closely with providers, nurse case managers, pharmacists, and other care team members to support the development of patient action plans (PAPs) for patients who are at high risk related to social, psychological, and/or environmental barriers that impact access to treatment and transitions within the continuum of care. This position is responsible for becoming familiar with available community-based resources and connecting patients with these resources, as needed.

The LCSW reports to the Clinical Manager with accountability for providing judgment, organization, and timely delivery of care. They should embody Care at Home’s core values, including Trusted, Empathetic, Committed, Humble, Creative, and Community-Minded.

Key Responsibilities

The LCSW will have the following responsibilities:

• Identify and enroll patients who would benefit from programs through assessment and risk screening

• Assist patients/families/caregivers through the healthcare system by acting as a patient advocate

• Complete appropriate assessments to evaluate a patient’s level of functioning for assigned patients

• Provides interventions that include counseling, family support, clinical referrals, and treatment for mental health disorders and addiction

• Facilitate provider contact and care team appointments as needed to coordinate patient’s care needs across the continuum of care

• Engage community resources that are timely and cost-effective to obtain optimum value for the patient in support of medical and social determinants of health

• Coordinate and make referrals to the appropriate community resources

• Foster a climate allowing for direct communication between the care team, patient/caregiver, and appropriate care providers to optimize outcomes

• Integrate knowledge of external and internal regulatory requirements into the review and management of cases

• Teach strategies and skills that help individuals or families overcome challenges

• Complete all appropriate documentation

The LCSW will also have the following duties:

• Leadership: The LCSW will work closely with the care team to identify high-risk patients who are appropriate for the population health management programs

• Collaboration: The LCSW will work closely with others to achieve the clinical objectives of Care at Home.

• Knowledge: The LCSW will provide solutions to assist in the development of patient action plans (PAPs) for patients who are at high risk related to social, psychological, and/or environmental barriers that impact access to treatment and transitions within the continuum of care.

• Culture: The LCSW is accountable for creating a productive, collaborative, safe, and inclusive work environment as part of the larger Company.

Required Qualifications

The LCSW should have the following qualifications:

• Education: Master’s degree in Social Work from a CSWE-accredited social work program required.

• Certification/Licensure: Active license for Clinical Social Work required.

• Experience: At least two to five years of experience working within a CBO, a provider office, or a government entity providing referrals to community resources, guidance on benefits, and mental health counseling for an underserved population.

• Entrepreneurial: Care at Home seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for self-motivation and direction to ensure Care at Home is positioned to innovatively deliver on its promise.

• Communication: Excellent verbal, written communication, and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to Care at Home team, investors, partners, and other stakeholders.

• Technology: Proficiency in all Microsoft Office applications as well as familiarity and willingness to learn EMR platforms.

• Relationships: Ability to build and effectively manage relationships with coworkers, clinical and business leaders, and external constituents.

• Culture: Good judgment, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial company.

• Unrestricted driver’s license in home state required.

• Ability to work collaboratively with healthcare teams and community organizations to address the complex needs of participants.

• Experience working with electronic medical records (EMR) and care management system.

• Strong knowledge of HIPAA regulations and ability to handle sensitive and confidential information with discretion.

Culture

• Good judgment, impeccable ethics, and a strong team player.
• Desire to succeed and grow in a fast-paced, demanding, and entrepreneurial company.

Our Benefits

Financial Well-being

• Competitive Compensation: We offer competitive salaries to attract and retain the best talent.
• 401(k) with Employer Match: Plan for your future with our 401(k) plan and a generous 4% employer match.

Health and Wellness

• Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
• Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
• Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
• Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.

Additional Perks

• Continuing Medical Education (CME) Allowance for Providers: Stay at the forefront of your field with our CME allowance.
• Commuter Benefits: Save on your commute with our commuter benefits program.
• Mileage Reimbursement: Get reimbursed for work-related travel expenses.

The working environment and physical requirements of the job include:

Work is performed indoors in a setting with conditioned air and artificial light. Travel to and work in offices or other environments is required.

In this position you will need an to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.