Social Worker 2

Social support navigation for social determinants of health (SDOH) such as food insecurity housing insecurity etc.

o Compile and maintain a resource list for SDOH resources including eligibility criteria referral process and contact information

o Collaborate with primary care nurse and providers

o Provide inperson or remote social needs screening/assessment with primary care patients referred by nurse or provider

o Coordinate or make aware of social services resources i.e. housing clothing food mental health services etc.

o Collaborate with other social workers to identify patient and community resources

Conduct case management activities

o Work with hospitals for discharge planning followup and education

o Assist with obtaining patient records from hospitals

o Assist in securing needed medical equipment through community partners

o Conduct followup on care plans

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

May assist with specialty referral navigation

o Schedule coordinate and track nonBCS specialist and imaging referrals

o Assist with obtaining patient records from specialists and imaging centers

o 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.

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

o 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

Tools and Equipment:

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

Minimum Verification Requirements

Please complete the following verifications with Info Cubic upon candidates selection. Additional verifications may be identified by the agency.

TN Package with TN Counties

• Criminal County/Statewide 7 years address
• Federal 7 years address
• Global Watch
• National Criminal Record Search
• Address Locator
• Sex Offender Registry
• AKAs Search current name and all additional names.

Breakout Invoice By Classification