Master Social Worker

Overview

At Suvida Healthcare, we are not just caregivers; we are compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos to help achieve our Higher Purpose?

We are an empowered primary care, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve.

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward

Position Summary

The Guia (Licensed Master Social Worker) is responsible for a panel of patients and, in collaboration with other members of a multidisciplinary primary care team, helps patients meet their preventive, chronic, and acute care needs.

The Guia will engage patients and encourage them to take an active role in their health by providing them with the tools necessary to make healthy lifestyle choices and adopt lifelong healthy behaviors. This individual’s primary responsibilities center around establishing trusting, supportive, collaborative relationships with patients and their families. Our Guias build relationships with patients in a clinical setting and in the community by working alongside medical providers, nurses, other Guias, medical assistants, and a behavioral health specialist in a collaborative and empathetic team to improve patient outcomes.

• Actively engage a panel of assigned patients within Suvida Healthcare
• Onboard patients to the Suvida model and their medical/social care visits
• Function as a patient advocate by attending patient appointments when requested/needed
• Document relevant information about the patient’s health and healthcare experience and perform health risk and social needs assessments.
• Collaborate with a multidisciplinary team to care for a population of patients and monitor and track whether patients are up to date on preventive measures.
• Provide patient education on acute and chronic disease management.
• Provide guidance to patients and families.
• Establish healing relationships with patients and families.
• Learn to employ confidence-promoting techniques in patient communication and develop patient self-efficacy to better manage health.
• Communicate with patients in-person and by phone, video conference, and text messaging.
• Collaborate with other members of the multidisciplinary care team including but not limited to the Guia manager, Transitions of Care manager, Medicaid case managers, and medical assistants.
• Coach patients using an action-planning model based on motivational interviewing techniques.
• Assist with the coordination of care across the continuum, such as: scheduling appointments with providers, coordinating referrals, and sharing or transferring information with the patient’s internal and external care team.
• Participate broadly in the daily operations of a primary care practice, such as:
  Answering incoming phone calls and messages and ensuring general upkeep of the clinical space.
• Track patient enrollment and progression through care programs.
• Other duties as assigned by the Guia Manager

Knowledge, Skills, and Abilities

• Experience in a customer service environment; some clinical…