Social Worker 2

The Clinical Care Team will take referrals from primary care providers and will work with the primary care team to accomplish the following tasks:

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 inperson 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

Conduct case management activities

Work with hospitals for discharge planning followup and education

Assist with obtaining patient records from hospitals

Assist in securing needed medical equipment through community partners

Conduct followup on care plans

Identify patients lost to followup or overdue for care and assist them in returning to care

May assist with specialty referral navigation

Schedule coordinate and track nonBCS 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

Assist patients to locate and access lowcost prescription options such as patient assistance programs discount retailers etc.

May assist with patient assistance program applications and serve as a patientprovider liaison with the drug companies

Assist patient with applications for programs such as CoverRx and RxOutreach

May help with other regional primary carebased initiatives with a social work component

Documents in patients record updates consults and tags provider and/or clinical staff as necessary

Provide patient education or find appropriate education resources

Expectations may include:

Complete onboarding and orientation

Participate in regional office and primary care clinical meetings as requested

Attend provider meetings as requested

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

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

1. Personal Computer

2. Telephone

3. Fax Machine

4. Printer

5. Scanner

6. Copy Machine

7. Calculator

8. Personal Vehicle

Other office related equipment as required

My3Tech is an IT services firm focused on catalyzing transformational IT initiatives of its clients through deep domain knowledge technology expertise and customer commitment. A trusted longterm service provider for various state governments across both the software product development and IT Staff Augmentation. Certified Minority Business Enterprise (MBE) with over 13 years of experience. We are CMMI Level 3 Certified for both IT Development and IT Services ISO 27001:2022 certified for Information Security Management and ISO 9001:2015 certified for Quality Management Systems.