Job Details
Company Mission
Duo Health is a new type of medical group designed around the needs of patients with chronic kidney disease and their physicians. Our unique Health Mobilization platform partners multidisciplinary care teams with community nephrologists and activates all the other clinicians, facilities and community organizations necessary to treat the whole patient on their own terms. Our team is comprised of leaders in value-based health care, technology and behavioral science who share a vision for advancing health equity one relationship at a time.
Our interprofessional care teams, which include physicians, nurses, social workers, and patient navigators, provide high-touch and comprehensive care to a small panel of patients. Team collaboration is essential to our intensive, psycho-social model of care which includes assessment, medication management, social management, and behavioral health management.
Job Description
The Social Worker is an ideal job for a proactive, self-motivated, positive individual who will work closely with the interprofessional care team to coordinate patient care and improve patient outcomes. The Social Worker will interface directly with a panel of patients with a focus on supportive services appropriate for the patient as well as providing short term-based Screening, Brief Intervention and Referral (SBIRT) services.
Duties and Responsibilities
- Collaborate with the core functional care team to provide psychosocial interventions and case management services to a patient panel.
- Interact with and evaluate patients in the home, via teleconference, or via telephone as appropriate.
- Identify and manage patients psycho-social conditions and obstacles to care.
- Determine the need for community-based organizations and resources as appropriate.
- Collaborate with health plan behavioral services, social services agencies, mental health providers, and other community agencies on behalf of patients.
- Educate patients and care team members about available social and mental health services.
- Determine the need for community-based organizations and resources as appropriate.
- Develop and implement comprehensive care plans for the patient panel.
- Document all medical encounters accurately and in a timely manner.
- Assist in the development and implementation of clinical protocols and guidelines of care in order to optimize outcomes.
- Support company efforts of continuous quality improvement.
- Adhere to all company policies and procedures.
Requirements
- Licensed Clinical Social Worker (LCSW) or MSW in the state of Florida.
- High level of clinical and case management expertise.
- Must meet Duo Health requirements for care team staff, including passing a background check and drug screen and meeting COVID-19 vaccine requirements.
- Reliable transportation and a verifiable good driving record. Must be able to travel to patient homes.
- Must be self-motivated and able to perform work in accordance with defined operating procedures.
- Ability to communicate effectively both orally and in writing.
- Must be comfortable interacting with patients and care teams both telephonically and in-person.
Working for Duo
- Competitive medical, dental and vision plans
- Paid maternity and paternity leave
- Educational Assistance Program
- Adoption Assistance
- Access to free wellness & personal development courses
- 401k plan with company matching
- Paid holidays and unlimited PTO
- A mission-driven approach to each and everything that we do, with an overall goal to improve health equity and health outcomes.