The Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) will serve as the Collaborative Care Manager. S/he will play an active role in the realization of all services relevant to the implementation of the DISRIP Coordinated Care (Impact) and Palliative Care Models. The Collaborative Care Manager will carry a caseload of Primary Care clients identified by the Primary Care Provider as being in need of treatment for depression and/or Anxiety as per results in PHQ2 and PHQ9 and GAD-7 screen results. S/he will play an active, collaborative role and will be responsible for providing Evidence-Based, Outcome-based Treatment to the assigned caseload. The Collaborative Care Manager may also perform other duties at the request of the Project Lead in support of model’s quality assurance process. The LCSW counselor reports to the Project Lead.
Utilize Psycho-education and Evidence Based approaches (i.e. Problem Solving Treatment; Behavior Activation Treatment; and Motivational Interviewing, CBT) in providing patient education, medication adherence to prescribe anti-depressants; to facilitate treatment change or refer clients to mental health; as appropriate.
The D&P CM tracks depression and/or anxiety or palliative care service outcome through conducting weekly depression screening via the application of the PHQ9 and/or GAD-7
Provides medication adherence/ medication management.
Communicates and routinely coordinates with the Primary Care Provider to inform the Provider’s stepped-care process and support relapse prevention once patient has improved.
Participates in case conferences to advance the on-going coordination of clients’ care.
Conducts diagnostic consultations with the Consulting Psychiatrist on difficult to manage case or case where patients are not improving.
Provides “Self-Management” support/option to clients who decline coordinated care services but are willing to engage in supported self-management goals.
Generates timely, accurate, and content substantive progress notes with treatment goals and interventions that are congruent with the clients’ diagnosis and consistent with the scope of the Coordinated Care Model.
Generates timely, accurate encounter forms with diagnoses and appropriate CPT Codes.
Partakes of one hour weekly supervision.
Support the implementation of Palliative Care workflow as needed.
Master’s degree in Social Work Current New York State LCSW; LMSW considered Qualified Supervisor- SIFI preferred
Demonstrated experience in providing psychiatric/mental health services/ individual, family, group therapy.
Good verbal and written communication skills.
Good interpersonal skills and ability to work in a team.
Knowledge of mental health symptoms, diagnoses, and treatment.
Ability to provide all supportive documentation and pass all accreditation standards.
Housing Works provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.
Minimum Education Required