HealthySteps Care Coordinator (LSW)
Position Summary
Saint James Health is seeking a Licensed Social Worker (LSW) to serve as the HealthySteps Care Coordinator supporting families with children from birth to age three. The HealthySteps Coordinator works as part of the pediatric care team to promote early childhood development positive parenting practices and family well-being through developmental screening care coordination brief interventions and connection to community resources.
This role is embedded within the pediatric clinic and aligns with Saint James Healths mission as a Federally Qualified Health Center (FQHC) to address medical behavioral and social determinants of health.
Essential Duties & Responsibilities
Care Coordination & Family Support
Serve as the primary HealthySteps Care Coordinator for families with children ages 03
Conduct brief evidence-based screenings related to:
Child development and milestones
Social-emotional development
Family needs and social determinants of health
Provide short-term strengths-based interventions and anticipatory guidance to caregivers
Support families with parenting strategies behavior concerns and early childhood development education
Clinical & Pediatric Team Integration
Work collaboratively with pediatric providers nurses medical assistants and behavioral health staff
Participate in pediatric team huddles and case discussions
Assist providers with identifying families who would benefit from HealthySteps services
Provide warm handoffs during pediatric visits as appropriate
Referrals & Community Resources
Connect families to internal Saint James Health services including:
Refer families to external community-based organizations (Early Intervention childcare housing food assistance parenting programs etc.)
Track referral outcomes and follow up with families to support engagement
Documentation & Compliance
Document all encounters screenings and interventions in Epic EMR
Ensure documentation meets HRSA Medicaid and HealthySteps program requirements
Maintain accurate tracking data and reports related to HealthySteps metrics
Comply with HIPAA patient confidentiality and Saint James Health policies
Program Support & Quality Improvement
Support implementation and sustainability of the HealthySteps model at Saint James Health
Participate in data collection reporting and quality improvement activities
Assist with grant reporting and audits as needed
Represent HealthySteps at internal meetings and community events when appropriate
Qualifications
Required
Bachelors or Masters degree in Social Work
Active New Jersey LSW license in good standing
Experience working with children families or early childhood programs
Strong knowledge of social determinants of health and community resources
Ability to work effectively in a fast-paced multidisciplinary healthcare environment
Proficiency with EMRs (Epic preferred)
Excellent communication organizational and documentation skills
Preferred
Experience in an FQHC pediatric or community health setting
Familiarity with the HealthySteps model
Bilingual (English/Spanish or English/Portuguese) strongly preferred
Experience with developmental screenings and early childhood interventions
Required Experience:
IC
HealthySteps Care Coordinator (LSW)Position SummarySaint James Health is seeking a Licensed Social Worker (LSW) to serve as the HealthySteps Care Coordinator supporting families with children from birth to age three. The HealthySteps Coordinator works as part of the pediatric care team to promote ea...
HealthySteps Care Coordinator (LSW)
Position Summary
Saint James Health is seeking a Licensed Social Worker (LSW) to serve as the HealthySteps Care Coordinator supporting families with children from birth to age three. The HealthySteps Coordinator works as part of the pediatric care team to promote early childhood development positive parenting practices and family well-being through developmental screening care coordination brief interventions and connection to community resources.
This role is embedded within the pediatric clinic and aligns with Saint James Healths mission as a Federally Qualified Health Center (FQHC) to address medical behavioral and social determinants of health.
Essential Duties & Responsibilities
Care Coordination & Family Support
Serve as the primary HealthySteps Care Coordinator for families with children ages 03
Conduct brief evidence-based screenings related to:
Child development and milestones
Social-emotional development
Family needs and social determinants of health
Provide short-term strengths-based interventions and anticipatory guidance to caregivers
Support families with parenting strategies behavior concerns and early childhood development education
Clinical & Pediatric Team Integration
Work collaboratively with pediatric providers nurses medical assistants and behavioral health staff
Participate in pediatric team huddles and case discussions
Assist providers with identifying families who would benefit from HealthySteps services
Provide warm handoffs during pediatric visits as appropriate
Referrals & Community Resources
Connect families to internal Saint James Health services including:
Refer families to external community-based organizations (Early Intervention childcare housing food assistance parenting programs etc.)
Track referral outcomes and follow up with families to support engagement
Documentation & Compliance
Document all encounters screenings and interventions in Epic EMR
Ensure documentation meets HRSA Medicaid and HealthySteps program requirements
Maintain accurate tracking data and reports related to HealthySteps metrics
Comply with HIPAA patient confidentiality and Saint James Health policies
Program Support & Quality Improvement
Support implementation and sustainability of the HealthySteps model at Saint James Health
Participate in data collection reporting and quality improvement activities
Assist with grant reporting and audits as needed
Represent HealthySteps at internal meetings and community events when appropriate
Qualifications
Required
Bachelors or Masters degree in Social Work
Active New Jersey LSW license in good standing
Experience working with children families or early childhood programs
Strong knowledge of social determinants of health and community resources
Ability to work effectively in a fast-paced multidisciplinary healthcare environment
Proficiency with EMRs (Epic preferred)
Excellent communication organizational and documentation skills
Preferred
Experience in an FQHC pediatric or community health setting
Familiarity with the HealthySteps model
Bilingual (English/Spanish or English/Portuguese) strongly preferred
Experience with developmental screenings and early childhood interventions
Required Experience:
IC
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