Summary/Position Objectives:

This position will be part of the Maryland Physicians Care (MPC) Social Determinants of Health team. This team works directly with MPC members to address social barriers to optimal health. This Social Worker will provide care management through a cooperative process of assessment, planning, facilitation and advocacy for options and services to meet member’s health needs through communication and available resources, while promoting quality cost-effective outcomes. Maintains members in the most independent living situation possible; ensures consistent care along the entire health care continuum by assessing and closely monitoring members’ needs and status.

What You’ll Do:

• Involved members of the SDoH team to develop, implement, and assist MPC SDoH programs.
• Utilize clinical judgment to assess members, prioritizing emerging issues to maintain a member-centric approach.
• Collaborate with the interdisciplinary care team to help members reach their health goals via case rounds and consultation.
• Complete assessments to better comprehend the Social Determinants of Health (SDoH) impacting member care goals.
• Utilize problem-solving skills to research and identify community resources and coordinate referral mechanisms.
• Plan specific goals, and actions designed to meet member’s needs as identified in the assessment process that are action-oriented, time-specific, and cost-effective.
• Implement specific activities and/or interventions that lead to accomplishing the goals outlined in the plan of care.
• Develop strong relationships with members by providing support and advocacy to help achieve health goals.
• Monitor care management activities, services, and members’ responses to interventions, to establish the effectiveness of the plan of care and the utilization of services.
• Evaluate the effectiveness of the plan of care in reaching desired outcomes and goals; make modifications or changes in the plan of care as needed.
• Participates in outreach activities to promote knowledge of the program and its services and to coordinate program activities with outside community agencies and health care providers.

Secondary Functions:

• Observe the confidentiality of member records following MPC policies and procedures.
• The hybrid position requires 2-3 days/week at community partner sites in Eastern Shore and Southern MD. 

Knowledge and Skills:

• Strong relational skills and the ability to work effectively with various constituencies in a diverse community.
• Knowledge of community agencies and resources (Southern and Eastern Shore MD).
• Ability to plan, implement, and evaluate individual client care plans.
• Computer literate, Microsoft Office preferred.

Education and Work Experience:

• Bachelor’s degree in social work required
  • Master’s degree preferred
• Maryland state LMSW or LCSW licensure in good standing required
• 3 years of experience in a community setting required
  • Knowledge of government-managed care programs preferred
• A valid Maryland State Driver’s License required

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment.

As a healthcare organization, we recognize the importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive.

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.