Social Workers - Hybrid (Per Diem)(Bilingual - Russian, Mandarin, or Cantonese Preferred)

Job Summary:The Social Worker is a member of the interdisciplinary care management team responsible for assessing and addressing members' psychosocial, behavioral, and social determinants of health needs. This role supports members and their families in navigating health, social service, and entitlement systems; promotes effective adjustment to illness or disability; and facilitates access to community resources to improve health outcomes, independence, and quality of life.Essential Functions:Conduct comprehensive psychosocial assessments to identify member needs, barriers to care, coping abilities, and social determinants of health.Develop, implement, and update care plans in collaboration with care managers, physicians, and interdisciplinary team members.Provide counseling, care coordination, and resource navigation to members and caregivers to support adherence to treatment plans and improve functional outcomes.Coordinate with internal teams and external partners (e.g., community agencies, skilled nursing facilities, physicians) to ensure continuity of care.Perform standardized assessments (e.g., cognitive, depression, suicide risk, functional status) as appropriate to support care planning.Assist members in accessing entitlement programs and community-based services.Monitor and document member progress, interventions, and outcomes in accordance with regulatory and organizational requirements.Participate in interdisciplinary team meetings and case conferences.Maintain timely, accurate, and complete documentation of all member interactions and services.Perform any other job related duties as requested.Education and Experience:Master's degree in Social Work (MSW) from an accredited program requiredOne (1) year of experience in healthcare or acute care setting requiredExperience in managed care or home health care preferredCompetencies, Knowledge and Skills:Knowledge of social determinants of health and their impact on member outcomesUnderstanding of applicable regulatory standards (e.g., CMS, Joint Commission, managed care requirements)Strong assessment, problem-solving, and care coordination skillsAbility to communicate effectively with diverse populations, including geriatric and medically complex membersDemonstrated ability to navigate community resources and entitlement programsStrong documentation and organizational skillsAbility to work collaboratively across interdisciplinary teamsProficiency in basic computer applications and electronic documentation systemsLicensure and Certification:Active licensure as a Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) in state of New York requiredWorking Conditions:This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential.Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.Must reside in the same territory ...