Site: Mass General Brigham Community Physicians Inc.
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Social Worker Geriatric Resources for Assessment and Care for Elders
Multiple Regions are hiring to support Boston North South East and West
Job Summary
The Opportunity
Mass General Brighams Population Health team is committed to enhancing the health care experience for older adults through personalized home-based care that supports independence functionality and quality of life. We develop innovative programs that deliver care where and when it is needed most.
This patient-centered model ensures that care is tailored to the unique needs of each individual. By leveraging interdisciplinary collaboration and proactive care management our value-based care models address the complex needs of older adults.
This is an exciting opportunity to join the Mass General Brigham Population Health department as a Social Worker within the GRACE (Geriatric Resources for Assessment and Care of Elders) program. The GRACE Social Worker will provide home-based geriatric assessment and care management for older adults aligned with Mass General Brighams Primary Care Providers. This role is designed to proactively support vulnerable older adults ensuring comprehensive coordinated care that aligns with their goals and preferences.
As part of this initiative the GRACE Social Worker will play a key role in:
in-home geriatric assessments in collaboration with a GRACE Nurse Practitioner.
and implementing individualized care plans using GRACE care protocols.
patients and caregivers in psychosocial support health education and goals-of-care discussions.
care with primary care providers and the GRACE interdisciplinary team to optimize outcomes and reduce unnecessary hospital utilization.
This role is an essential part of Mass General Brighams commitment to improving care delivery for high-risk older adults through proactive patient-centered management. The GRACE Social Worker will build strong lasting relationships with patientsoffering culturally responsive care continuity and education to help manage complex social and health conditions and promote maximum functioning.
We are seeking a full-time 40-hour Social Worker with weekly schedules consisting of 36 hours of clinical patient-facing time and 4 hours of administrative time. This will be a hybrid role with the expectation that the Social Worker will conduct home visits in the Boston/Boston metro area up to 2 days per week and work remotely for the remainder of the week.
Potential Primary Care clinics include:
Key components of GRACE Team Care include:
- In-home assessments by a nurse practitioner and social worker team.
- Individualized care plans developed using GRACE protocols.
- Collaborative care planning with primary care physicians.
- Ongoing home-based care management and coordination.
- Weekly interdisciplinary team meetings including a geriatrician pharmacist and mental health liaison.
As an independent practitioner of social work the GRACE Social Worker evaluates psychosocial needs and applies social work interventions with a high degree of autonomy exercising independent judgment and initiative in carrying out social work functions and in applying social work values and ethics to complex situations.
- Masters Degree Mental Health & Behavioral Medicine required or Masters Degree Social Work required
- Class D Passenger Vehicle Drivers License State License
- Preferred Licensed Clinical Social Worker LCSW - State License
- Preferred Licensed Independent Clinical Social Worker LICSW - State License
- Licensed Mental Health Counselor LMHC - State License
- Clinical Experience in a medical setting 2-3 years required
Skills for Success
- Demonstrates proficient clinical judgment and application of professional values and ethics. Integration of prior clinical experience into current practice.
- Demonstrates proficiency to formulate assessment of risks crisis intervention psychosocial assessments treatment plans and the documentation of both in a timely manner.
- Demonstrates sound clinical judgment and innovation in advocating for clients while maintaining professional boundaries.
- Demonstrates proficient working knowledge of internal and external resources and refers appropriately.
- Provides a range of evidence-based interventions.
- Ability to advocate coordinate and continuously communicate with treatment plans with patients family and the interdisciplinary team.
- Incorporates social sensitivity.
- If appropriate utilizes supervision and consultation regularly and appropriately.
- Actively seeks assistance with complex case s and situations in a timely manner.
- Engages in quality improvement projects uses data to measure progress.
- Facilitate skill-based groups.
- Knowledge understanding and ability to negotiate and work in a complex organization.
- Demonstrate capacity to effectively communicate findings with a broader audience.
Additional Job Details (if applicable)
Regions and Working Model
- M-F Eastern Business Hours required
- Hybrid role requires regional coverage for assigned region
- Region will be determined based on candidate preference and business needs
- Regions include Boston and surrounding North Shore South Shore East of Boston and West of Boston
- Includes in home patient visits for evaluation for care plan patient home will be within 45 miles of practices within the region
- Estimated 10 home visits per week travel includes 4-5 days per week and MGB sites.
- Formal structured training program for 60-90 days prior to patient home visits
Hybrid
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$66206.40 - $96304.00/Annual
Grade
7
At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Mass General Brigham Community Physicians Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
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