Clinical Social Worker (Licensed or Associate)

Job Title: Clinical Social Worker(Licensed or Associate)
Salary: $95,000 (at 40 hrs/week) licensed ($45.67/hr); $75,000 (at 40 hrs/week) associate ($36.06/hr)
Hours: 32-40 hrs/week
In Person Expectation: 100% In Person
FSLA Status: Non-Exempt
Primary Location: Lyon-Martin Community Health Services
Address: 1735 Mission Street San Francisco, CA 94103
Reports To: Director of Case Management
Revision Date: 10/08/2024
Organization Mission
The mission of Lyon-Martin Community Health Services is to provide high quality, compassionate and trauma-informed medical, gynecological, and mental health care services to trans, non-binary, gender non-conforming, and intersex communities and cis-gender women with specific sensitivity to LGBQA+ sexual orientation, disability, size, race, ethnicity, and language, regardless of immigration status or ability to pay.
We aim to eliminate health inequities for our communities by rooting our clinical practice in core foundational intersectional frameworks of anti-racism, self-determination, harm reduction, and reproductive and disability justice. As a community clinic, we believe our communities are best served by and for us; that's why community outreach, engagement, and leadership development are central to our mission of community care and mutual aid. Lastly, we commit to increasing access to culturally responsive care beyond our walls through provider training and education, and policy advocacy.
Job Summary
The Clinical Social Worker (CSW) provides comprehensive case management services to patients of Lyon-Martin. Working closely with a multidisciplinary team, the CSW assesses patient needs, coordinates care, and connects patients to medical, mental health, and social services. They are responsible for providing clinically appropriate Case Management and Crisis Intervention services, including but not limited to: substance use disorder counseling, crisis intervention and de-escalation, safety planning, and appropriate internal/external referrals. The CSW is expected to maintain a high degree of professional competence and the highest possible ethical standards, and to work collaboratively as part of an integrated health care team.
Key Responsibilities

• Conduct comprehensive intake assessments, including medical, psychological, and social factors, to identify patient needs and goals, as well as social determinants of health that may impact well-being, such as challenges with stable housing, employment or food access.
• Develop individualized care plans that address the physical, mental, and social well-being of the patient.
• Collaborate with the patient, their family, and their care team to establish goals and interventions tailored to their needs and desires.
• Serve as a liaison between patients, healthcare providers, and external organizations to ensure their care is coordinated and that there is shared consent and understanding of care plans, empowering them to make informed decisions about their care.
• Assist patients with scheduling appointments, arranging transportation (Paratransit, Tokens, Lyft), interpretation access, and navigating the healthcare system, assisting patients in overcoming barriers to care. May accompany clients to appointments.
• Provide and coordinate referrals and assist with the completion of paperwork to ensure access to appropriate wraparound services, such as housing (Coordinated Entry, Our Trans Home, Open House), financial assistance programs (CAAP, GA, guaranteed income programs, SDI, SSDI), food resources (SNAP, Project Open Hand, Meals on Wheels, Lyon-Martin's Community Fridge), In-Home Support Services, higher-level mental health services, and more.
• Provide immediate triage and intervention for patients presenting with suicidal ideation or mental health crises.
• Conduct risk assessments to determine the level of care required, including the need for emergency psychiatric services, intensive outpatient programs, residential or inpatient treatment.
• Develop safety plans with the patients in crisis, including participating in follow-up care and monitoring. Develop preventative strategies and conduct regular check-ins or provide a warm-hand off to accessible mental health services.
• Maintain open communication with the care team to ensure patient safety and well-being throughout and after the crisis.
• Collaborate with team to ensure access to long-term care and recovery.
• Lead restorative justice and accountability conversations with clients who break Lyon-Martin's community agreements, focusing on building a shared understanding of motivations behind their behavior and supporting clients in planning for future situations where they. May struggle to meet expectations, ensuring appropriate resources and plans are in place.
• Facilitate discussions about why the behavior was unacceptable, harm caused, and work with the client to agree on a commitment to appropriate behavior in the future.
• Communicate consequences clearly if behavior is repeated and follow through on those consequences in collaboration with the care team.
• Maintain accurate, timely documentation of all case management activities, including crisis interventions and accountant ability processes in the EHR, Epic.
• Complete all visit notes and respond to in-basket messages within 72 hours, same day if urgent.
• Regularly monitor patient progress and update care plans to reflect changes in their condition or situation.
• Meets productivity and quality indicator benchmarks, maintaining caseload of paneled patients seen at a minimum of 3 patients per half day.
• Adhere to all FQHC, federal, state, and city regulations, including HIPAA to ensure patient privacy and confidentiality.
• Participate in weekly Case Management Team Meetings, Collaborative Care Meetings, All Staff Meetings, and any applicable subcommittee meetings to discuss patient care with the integrated multidisciplinary team with the aim of improving patient experience and health outcomes, especially for high-risk or complex cases.
• Engage in professional development to stay informed on best practices in case management, crisis intervention, restorative justice, and patient care.
• Engages with clients who have high no-show rates or utilize emergency care at high rates to support access to care.
• Facilitate group(s) therapy to foster safety, consistency, and connection to community, as needed.
• Accompanies clients to referral or social services appointments as needed.

Competencies:

• Mission-driven: demonstrates commitment to mission of the organization, queer, intersex and trans health, and community-driven primary care.
• Teamwork: reaches out to peers and cooperates with supervisors to establish an overall collaborative working relationship; treats everyone with dignity regardless of their level or background. Accountable to team; participates effectively in group- and team-work; collaborates positively with other team members; giving and accepting constructive criticism.
• Communication: Delivers written communications that have clarity and impact including emails. Effective listener; clearly and thoughtfully communicates with others in person and on the phone. Strives to understand the viewpoints of others. Maintains professionalism in all communications. Asks for support when needed.
• Reliability: Accountable; maintains focus; punctual; good attendance record; meets deadlines.
• Customer Service: Persists in efforts to solve issues even when faced with internal barriers; accountable to outcomes; responds quickly and effectively to requests for assistance and support whether internal or external; asks questions when unsure of the answer.
• Computer Literacy: Skilled computer-based work tasks; uses technology to enhance job performance. MS Office, Excel, Word and/or Powerpoint.
• Tolerance for Stress, Ambiguity, and Change: Maintains composure while under pressure; handles complex problems and change with grace; demonstrates flexibility and versatility in achieving key goals and priorities.
• Attention to Detail: Strives to eliminate errors; makes accurate work a priority; seeks opportunities to improve performance.
• Decision Making: Collects, organizes, and analyzes information before making decisions. Takes a thoughtful approach when considering options; may seek supervision and/or input from others.
• Integrity and Ethics: Actively models the highest ethical standards; is honest and accountable; maintains confidentiality and appropriate boundaries at all times; handles sensitive information and issues with discretion and tact.
• Presentation Skills: Adapts presentation techniques to fit audience level and technical needs; develops and delivers communications that have clarity and impact; conveys confidence, presence, and professionalism; uses appropriate visual aids to illustrate key points and enhance learning.
• Accountability: Makes and meets commitments; accepts responsibility for behavior and outcomes.
• Follow Through: Monitors status of projects and tasks; thoroughly deals with project details; delivers clear, accurate depiction of status.
• Cultural Humility and Sensitivity: Ability to work with a diverse population while withholding judgment. Willingly open to learn and understand different perspectives.
• Intelligence: learns quickly; demonstrates ability to proficiently understand and absorb new information
• Creativity/innovation: generates new and innovative approaches to problems.
• Enthusiasm: exhibits passion and excitement over work; has a can-do attitude
• Work ethic: possesses a strong willingness to work hard to get the job done.

Education, Knowledge, Skills:

• Graduation from an accredited school of social work.
• Licensed in California as an LCSW or ASW.
• Extensive knowledge of Bay Area public benefit resources and networks.
• Excellent de-escalation and non-violent communication skills.
• Experience safety planning for individuals in crisis, particularly those with suicidal ideation.
• Experience mediating using a restorative justice principles and practices; ability to facilitate accountability conversations.
• Strong interpersonal skills, with an emphasis on empathy and patient-centered care.
• Culturally sensitive/humble and able to work with diverse populations.
• Strong proficiency with EHR systems, Microsoft Office applications, specifically Word, Outlook, internet applications, zoom, computer technology, and phone use
• Experience working with lesbian, bisexual, transgender, gender non-conforming, non-binary, and intersex communities, populations with varying disabilities, racial, ethnic and cultural backgrounds and economic statuses, people who do sex work, those experiencing homelessness, people who have challenges with severe mental illness, people who use drugs, those of with a history of incarceration, people of varying ages.
• An interest in and commitment to accessible gender affirming health care, abortion and primary care for marginalized populations.

Preferred:

• LCSW
• Bilingual Spanish/English fluency; other bilingual or multilingual fluency
• Experience using Epic
• At least 2 years of experience providing case management in a community clinic or hospital setting.

Benefits: Employees regularly scheduled for 16 hours or more per week are eligible for full benefits, including 100% employer paid Platinum level medical plans for both employees and their minor dependent(s), Premium dental, vision, life and acupuncture/chiropractic plans, as well as an up to 3% 403b match and access to pre-tax health, dependent care and commuter benefits, as well as professional development funds.
Available Pay Differentials: $1.00 per hours worked for employees certified bilingual in Spanish, Chinese, or Tagalog.
Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.