Associate Social Worker or LCSW; Healthy

Overview

Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all.

Marin Community Clinics is looking for a mission-driven Associate Social Worker (ASW) or Licensed Clinical Social Worker to join our dynamic, multidisciplinary, Complex Care team to advance our goal of improving health outcomes for children with complex medical, behavioral health, and psychosocial needs. Our Complex Care team is committed to increasing health equity among Marin’s most vulnerable patients through person-centered, trauma-informed, case management and behavioral health supports.

Working collaboratively with primary care providers and other members of the clinical care team, the ASW Pediatric Complex Care Provider works as a member of an expert team of professionals to provide patient-centered, outcome-driven care that promotes independence and dignity.

To this end, The Pediatric Complex Care Provider will offer Healthy Steps BH interventions and/or comprehensive case management support to a panel of children and families with the goals of minimizing barriers to care, improving health outcomes, and helping families increase capacity to manage their needs with greater independence. The Pediatric Complex Care Provider role is a patient-facing role that aims to build engagement and trust with vulnerable children and families.

The Pediatric Complex Care Provider will report to the Director of Complex Care.

We are looking for a Complex Care Provider who:

• Understands how ACES/trauma may impact childhood development.
• Understands the interplay between chronic conditions and psychosocial issues.
• Demonstrates cultural humility when working with families and children.
• Demonstrates compassion for and understanding of issues related to homelessness.
• Is comfortable working with individuals with complex behavioral health presentations and/or substance use disorders.
• Has passion for helping individuals navigate a complex system of care.
• Is a team player and welcomes guidance from multidisciplinary team members.
• Demonstrates initiative, creativity, and enjoys problem solving.
• Is comfortable working with community partners including community based organizations (CBOs), Marin County, medical/BH specialists, and insurance providers.
• Ascribes to the tenets of person-centered, trauma-informed, housing-first care.
• Demonstrates compassion and respect for individuals served in all interactions.
• Has excellent organizational skills.
• Demonstrates a willingness to be flexible and adaptable in all aspects of this work.

• Provide BH/Healthy Steps supports to vulnerable families
• Provide intensive case management services to a small caseload children/families
• Triage and respond to tasks/care needs
• Assist families to complete necessary forms/applications
• Work with families to address social determinants of health (SDOH)
• Assist families in getting connected to community resources
• Track referrals and provide follow-up to ensure service delivery
• Assist patients to schedule/attend medical, BH, and specialist appointments
• Administrative support including records retrieval and review, eligibility screening, goal tracking, and more
• Assist patient to coordinate all necessary care
• Conduct home/community visits as needed
• Consult/coordinate with interdisciplinary care team, including behavioral health, care navigation MAs, nursing, medical providers, and external partners
• Document all Patient interactions and services using MCC’s electronic health record AND secondary database
• Attend internal and external meetings (i.e. case conferencing, administrative)
• Attending trainings such as health coaching, engagement techniques, etc.
• Timely and accurate reporting of data as requested to MCC CM programs
• May travel between clinics or meet…