Job Title: Licensed Clinical Social Worker
Location: Puerto Rico
Schedule: Monday thru Friday 8:00am - 5:00pm

About Emcara Health Value-Based National Medical Group: Our mission is simple - leading the effort to reimagine how health care is delivered for our nation's most vulnerable seniors and adults. Improving the lives of those most in need guides everything we do, and we believe that as we continue to stay focused on that compass heading, we will increasingly be recognized as America's leading national medical group providing house calls for vulnerable populations.

We have brought the same focus to the experience of our own team members as we have to our patients, and through the prioritization of Joy In Work have made the Quintuple Aim in health care delivery our clinical true north.

Emcara core care teams are multi-disciplinary and include Community Health Workers (CHW), Registered Nurses (RN), Advanced Practice Providers (APP- NP/PA), and Physicians (MD/DO), among other care coordination and specialized resources such as palliative care and behavioral health clinicians, Clinical Pharmacists, Pharmacy Technicians, Social Workers (SW), Physical Therapists, and Registered Dieticians (RD).

Our care teams understand that vulnerable populations require a new brand of care to live their healthiest life possible- home-based advanced primary care. Advanced primary care is comprehensive, and includes medical, behavioral, and social care, and can be delivered either as the PCP of record, or in collaboration with patient PCPs to deliver an added layer of support.

Value-based payment methodologies allow our physicians and APPs both the time they need to restore the clinician-patient relationship, as well as ensure the patient and clinician are surrounded by a care team that can address all of their care needs, especially their behavioral and social needs.

Position Overview: We are seeking a LCSW to be part of a multi-disciplinary care team to provide health care system navigation support, social support, and resource navigation in Puerto Rico.

In day-to-day operations, the LCSW receives Emcara patient referrals, performs chart reviews, engages patients in their home, via telehealth or telephonic communication modalities. As part of the shared care plan, the LCSW collaborates closely with care team who support patients with self-management goals, and reviews cases with the providers as needed.

Key Responsibilities:

• Facilitates the social, financial, and additional support needs of the patient and/or caregiver.
  • Receives internal "referrals", performs chart reviews, engages patients in home, telehealth or telephonic assessments and follow-ups.
  • Engages in shared care planning and care coordination activities with clinical field team and external supports (e.g., health plan Departamento de la Familia), as needed.
  • Supports clinical care team with monitoring adherence, side effects and effectiveness of treatment.
  • Participates in multi-disciplinary, team discussions and huddles.
  • Documents clinical and care coordination progress in EMR and Population Health Management Tools.
• Collaborate with multi-disciplinary stakeholders for clinical care of the patient.
• Provide training and education for other practitioners as needed.
• Assist the field team with ad hoc projects, as indicated.
• Other duties as assigned.

Qualifications:

We are searching for a health care professional who embodies the following qualities and characteristics: commitment to serve vulnerable populations, and team-based and social determinants of health orientation. They must possess clinical skills, time management, and organizational skills, with the ability to prioritize and multi-task.

Additional qualifications include:

• Master's degree in social work, with full licensure as a clinical social worker
• Must hold an active, unrestricted, LCSW license in indicated state. Must hold and maintain membership in the Puerto Rico College of Social Work
• Obtained cognitive behavioral therapy certification (preferred)
• Experience: At least 5 years of clinical experience (preferred)
• Experience: At least 2 years in care coordination or case management (preferred)
• Must be bilingual, Spanish dominant.
• Basic knowledge for common health disorders that is within appropriate scope of practice.
• Experience in collaborative care and team-based models (preferred)
• Experience in patient/team education, medical social work, clinical supervision (preferred)
• Strong written and oral communication skills, as well as an ability to collaborate both internally and externally with multi-disciplinary stakeholders.
• Current Certification in AHA or ARC Basic Life Support for health care providers required for employment.
• Strong working knowledge of computers and ability to document effectively and efficiently in an electronic medical record system
  

.