Complex Care Social Worker

Job description

Department Overview The Social Worker in the Complex Care role supports individuals with high needs, such as severe chronic illnesses, functional limitations, traumatic brain injury, mental health, and or comorbid substance use conditions, significant social barriers (e.g., housing, poverty, criminal justice involvement), long- term care and guardianship cases. The CCSW is involved in managing complex, high-risk cases with a focus on patient advocacy and reduction in patient length of stay and hospital readmission. The CCSW will perform biopsychosocial assessments, manage care, advocate for services, and connect patients to resources to improve health outcomes and quality of life. The social worker partners closely with multidisciplinary teams to establish patient care needs and establish plans for discharge to the most appropriate level of care. The Complex Care Social Worker is an identified expert in mental health issues and provides consultation and educational programming to OHSU staff and the community. Function/Duties of Position: Care Coordination: - Navigating complex healthcare systems and bridging the gap between medical care and social circumstances. The social worker p...