Social Worker; MSW​/LMSW

Social Worker (MSW/LMSW)

Join our family as a Social Worker (MSW, LMSW) and help patients and families navigate medical, psychosocial, and basic-needs services with compassion, skill, and respect. Working alongside Legacy providers within a primary care medical home, you will offer case management, linkages to care, patient advocacy, and psychological and social support.

Your work will create meaningful impact in community healthcare by helping people overcome barriers, understand their care, and build the confidence to advocate for themselves. You will develop trusted relationships with patients and families while collaborating with medical professionals, community agencies, and fellow employees as part of a team-centered approach to whole-person care.

• Make a direct difference by connecting patients with timely, culturally sensitive, and language-appropriate care.
• Support continuity of care while helping patients strengthen self-management and advocacy skills.
• Collaborate with a compassionate care team to address medical, psychosocial, and basic needs.
• Build relationships through outreach, education, follow-up, and patient-centered advocacy.
• Contribute to quality improvement, performance assurance, and accurate, consistent documentation.
• Grow professionally through required training, ongoing education, and specialized program certification.
• Support Medicaid's Case Management for Children and Pregnant Women Program (CPW), including maintaining a caseload when applicable to licensed staff.
• Travel between locations as needed and support Walk-in Behavioral Health/Social Work patients when needed.

• Work within the context of a primary care medical home, applying a team-based approach to care.
• Partner with patients and families to promote timely access to care, culturally sensitive and language-appropriate understanding of care, continuity of care, and whole-person improvement through appropriate self-management skills.
• Identify and screen individuals referred for social service needs from all Legacy service lines.
• Assess each patient's medical and psychosocial history as it pertains to current service needs.
• Provide information, referrals, and assistance with linkage to medical, psychosocial, and basic-needs services as needed or requested.
• Conduct outreach to new patients and families, including follow-up on missed appointments.
• Advocate on behalf of patients to decrease service gaps and overcome barriers to services.
• Complete requests for P.A.'s to approve services, as necessary.
• Educate, support, and empower patients to learn and utilize self-management and advocacy skills in order to understand their rights, advocate for their needs, and overcome barriers to services.
• Monitor the efficacy and quality of services through periodic re-evaluation with peers and supervisor.
• Adhere to all department guidelines and standards to maintain accurate, timely, and consistent documentation.
• Participate in Legacy's Performance Improvement and Quality Assurance Program.
• Attend training by DSHS/HHSC to become certified under Medicaid's Case Management for Children and Pregnant Women Program (CPW) and maintain a caseload of CPW patients (licensed staff).
• Follow program standards and protocols, including completing Comprehensive Assessments and Service Plans with approved patients.
• Maintain paperwork and documentation necessary for program standards.
• Stay abreast of all program updates through quarterly webinars and DSHS/HHSC communication regarding program policy updates and changes.
• For Social Workers seeking Clinical Supervision, maintain a direct patient care caseload within the Behavioral Health department, including assessment, diagnosis, and treatment of clients with clinical needs in individual and group settings.
• Meet with the LCSW Supervisor on-site for Clinical Supervision sessions in accordance with Texas State Board of Social Work Examiners requirements.
• Take Risk Assessment calls as needed per service line directive.
• Attend one community coalition or community case management meeting monthly.
• Assist with onboarding new Social Service staff when needed.
• Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
• Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.
• Attend required training and…