Bilingual Social Worker (Lcsw/Lmsw)

• Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care.
  


• 3-4 Days of Home Visits (within 1 Hour Radius of Assigned Territory) and 1-2 Days of Telehealth
  


• Coordinating Services for the underserved population not providing direct therapy
  


• Competitive salary and bonus.
  


• Flexible paid leave and vacation policy.
  


• Laptop, mileage reimbursement, phone allowance, and extra perks available!
   

Responsibilities

• Perform in-home care management visits to assess and impact social and behavioral status
  


• Work closely with Care Team to ensure continual progress on all care management goals
  


• Assess social determinants of health needs and develop a plan for addressing them
  


• Perform behavioral, environmental and social support assessments and surveys as needed
  


• Deliver individual, family and group education on living with chronic illness
  


• Engage family and social support groups in the education and care of patients
  


• Assess patients and refer to behavioral health specialists if diagnosis and treatment needed
  


• Help patients to understand, accept and follow medical and lifestyle recommendations
  


• Serve as the point of contact for patient questions regarding social and behavioral
  


• Facilitate conversations around and consideration of proactive care decisions, especially relating to transplantation, home modalities and AV fistula placement
  


• Initiate patient relationships through enrollment and onboarding processes
  


• Review and document patient updates and progress in care management platform.
  


• Identify, vet and build relationships with local Community-Based Organizations
  


• Introduce patients to appropriate resources and act as the patient advocate
  


• Serve as subject matter expert on social determinants for other members of the Care Team
  


• Occasionally visit patients or take call remotely on some nights and weekend
  

Requirements

• Master’s Degree in Social Work, behavioral sciences or other related field
  


• Must be a Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) in the State of New Mexico
  


• 2+ years previous experience working in care management and/or with chronic illness within a medical environment i.e. home health, dialysis, hospice 
  


• Ability to show empathy and quickly build relationships with patients and local CBOs
  


• Ability to occasionally visit patients or take call remotely on some nights and weekends
  


• Must be fluent in Spanish
  


• Excellent verbal communication skills both in person and on the phone
  


• Ability to work with Microsoft Office and mobile phone and web-based applications
  


• Self-starter with the ability to work independently with minimal supervision
  


• Must be a road warrior! A lot of driving involved.
  


• Ability to travel to company main location in Nashville for training if necessary
  


• Must live within 30 miles of Albuquerque