License Clinical Social Worker

Harmony Cares is seeking a Licensed Clinical Social Worker to join our home-based primary and palliative care team serving medically complex, home-limited patients. In this role, you will conduct comprehensive psychosocial assessments, provide counseling, and coordinate community resources to address social, emotional, and environmental needs. You'll collaborate closely with physicians, nurses, and care managers through in-home visits and telehealth to reduce avoidable hospitalizations and support patient goals of care.

Harmony Cares offers a compassionate, patient-first culture, mission-driven work, and opportunities for professional growth in an evolving healthcare model.

Responsibilities

• Provide in-home psychosocial assessments and ongoing counseling for medically complex, home-limited patients
• Develop and implement patient-centered care plans in collaboration with physicians, nurses, and care managers
• Coordinate community resources, benefits, and support services to address social determinants of health
• Conduct crisis intervention, risk assessments, and safety planning as needed
• Participate in interdisciplinary team meetings to review cases and optimize patient outcomes
• Maintain timely, accurate clinical documentation in the electronic health record
• Educate patients and caregivers on coping strategies, advance care planning, and care options
• Support palliative and end-of-life care planning aligned with patient goals and values

Required Skills

• Clinical psychosocial assessment
• Individual and family counseling
• Care coordination and case management
• Crisis intervention and risk assessment
• Knowledge of community and social service resources
• Electronic health record documentation
• Interdisciplinary team collaboration
• Advance care and end-of-life planning
• Motivational interviewing
• Telehealth service delivery