Licensed Clinical Social Worker (LCSW) at Strategic Management Solutions, LLC.

Fort Myers, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

18 Jun, 26

Salary

0.0

Posted On

20 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Care Coordination, Social Determinants Of Health, Behavioral Health, Chronic Disease Management, Crisis Management, Advance Care Planning, Patient Education, Case Management, Health Systems Navigation, Interdisciplinary Teamwork, Documentation, HIPAA Compliance, Screening Tools, Therapeutic Interventions

Industry

Description

Physicians’ Primary Care of Southwest Florida is a premier physician owned and managed primary care practice with locations in Cape Coral, Estero, Fort Myers, and Lehigh Acres. We are currently seeking Licensed Clinical Social Worker (LCSW) for our Family Practice Division in Fort Myers, FL. This position is conveniently located in our Administration building located off of College Parkway. This is a full-time position. The schedule is flexible, Mon-Fri, Days. General Summary Duties: The LCSW will support patients and families by addressing behavioral health needs, care coordination, and social determinants of health. This role is central to providing whole-person, team-based care by connecting clinical, behavioral, and community resources in a primary care setting. Supervision Received: Reports directly to the Care Management Supervisor. Supervision Exercised: None Typical Physical Demands: Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordinator and manual dexterity sufficient to operate a computer, telephone and other office equipment. Occasionally lifts and carries items weighing up to 30 pounds. Requires vision and hearing to normal range. Typical Working Conditions: Outpatient clinical office setting in a fast-paced primary care practice. Key Responsibilities: (This list may not include all of the duties assigned.) 1. Care Coordination * Support care coordination by working with case managers, community partners, and health plans to address social determinants of health. * Help patients navigate complex health systems and advocate for seamless access to care. * Coordinate between primary care providers, specialists, behavioral health professionals, and community resources. * Work with care management staff to support, implement and carry out programs in chronic disease management for patients with such problems as diabetes, coronary artery disease, COPD and congestive heart failure. * Regularly review registry information for assigned panel of patients and arrange for care needed to proactively coordinate healthcare needs. 2. Addressing Social Determinants of Health (SDOH) * Identify and mitigate barriers such as housing instability, food insecurity, lack of transportation, and financial hardship. * Collaborate with community agencies to connect patients with essential services. * Assist patients with navigating social services, including housing, transportation, food insecurity, insurance, and financial assistance programs. 3. Mental Health Support * Educate patients and families on behavioral health strategies, coping skills, and community resources. * Screen for depression, anxiety, substance use, and trauma using evidence-based tools (e.g., PHQ-9, GAD-7). * Refer patients to the practice’s integrated behavioral health managers. * Provide brief therapeutic interventions and coordinate referrals for long-term behavioral health care. 4. Chronic Disease Management Support * Collaborate with patients to improve adherence to treatment plans, medication regimens, and self-care strategies. * Promote behavioral change and connect patients with relevant health education and support. 5. Patient and Family Education * Provide education on chronic conditions, treatment options, and available support services. * Help families understand diagnoses and care expectations, especially for complex or long-term conditions. 6. Advance Care Planning * Facilitate discussions on goals of care, advanced directives, POLST forms, and end-of-life preferences. * Collaborate with medical staff to ensure documentation aligns with patient wishes. 7. Crisis Management * Provide immediate intervention and safety planning in cases of abuse, neglect, homelessness, or suicidal ideation. * Deliver crisis intervention and safety planning as needed. * Coordinate with crisis teams, adult/child protective services, shelters, and emergency responders as needed Additional Responsibilities: * Provide an effective communication link between patient and medical staff. * Ensure that all patients are tracked and data entered into systems for follow-up and reporting. * Maintains accurate and timely documentation. * Participate in team decisions regarding data requirements for pro-actively managing the team’s panel. * Maintains working knowledge of payer requirements. * Ability to work independently, while collaborating with other team members. * Ability and willingness to self-motivate, prioritize, and be willing to change processes to improve effectiveness. Adapts to changing patient or organizational priorities. * Works at maintaining a good rapport and a cooperative working relationship with providers, staff and patients. * Participate in interdisciplinary team meetings and contribute to care planning and case reviews. * Maintain accurate and timely clinical documentation in the electronic health record (EHR). * Follow ethical, legal, and regulatory standards of care and maintain confidentiality. * Maintains patient confidentiality and protected health information (PHI) in a manner consistent with HIPAA. * Bilingual staff may be called upon to interpret, if needed, provided the employee speaks the needed language and is available to interpret. * Performs related work as required. Qualifications: * Master’s degree in Social Work (MSW) from an accredited institution. * Current and active LCSW license in the state of Florida. * Minimum of 2 years of clinical experience, preferably in a primary care, outpatient, or integrated care setting. * Strong understanding of social determinants of health and community-based resources. * Familiarity with social service systems and community-based care coordination. * Excellent communication, collaboration, and organizational skills

Responsibilities

The LCSW will support patients and families by addressing behavioral health needs, coordinating care, and connecting them with clinical, behavioral, and community resources within a primary care setting. Key duties include care coordination, addressing social determinants of health, providing mental health support, and assisting with chronic disease management.