Licensed Clinical Social Worker

Harmony Cares is seeking a Licensed Clinical Social Worker to provide home-based psychosocial care to medically complex, home-limited patients. In this role, you'll conduct comprehensive assessments, deliver counseling and crisis intervention, and coordinate access to community resources and benefits. You will collaborate closely with physicians, nurses, and care managers to create patient-centered care plans that reduce avoidable hospitalizations and improve quality of life.

Working in a mission-driven, interdisciplinary team, you'll support patients and caregivers through education, advance care planning, and ongoing emotional support while maintaining accurate clinical documentation.

Responsibilities

• Provide home-based clinical social work services to medically complex, home-limited patients and families
• Conduct psychosocial assessments and develop person-centered care plans
• Coordinate with physicians, nurses, and care managers in an interdisciplinary team
• Deliver counseling, crisis intervention, and supportive therapy
• Connect patients and caregivers with community resources, benefits, and social services
• Advocate for patient needs, safety, and access to care
• Participate in care conferences and contribute to treatment planning
• Maintain accurate, timely clinical documentation and reports
• Educate patients and families on coping strategies, advance care planning, and care options
• Support care transitions to reduce avoidable hospitalizations and ER visits

Required Skills

• Clinical psychosocial assessment
• Individual and family counseling
• Care planning and coordination
• Knowledge of community and social service resources
• Crisis intervention
• Electronic health record (EHR) documentation
• Interdisciplinary team collaboration
• Motivational interviewing
• Care management and discharge planning
• Telehealth and remote patient support