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Social Worker

Requisition R047974 Market Youngstown, OH Department Care Coordination - Population Health Service Organization Shift Days Schedule Full-time

Thank you for considering a career at Bon Secours Mercy Health!

Job Description Template


February 27, 2019

Job Title:

Social Worker

Reports to:

Manager Care Coordination

# Direct reports:


Summary of Primary Function/General Purpose of Position (2-3 sentences)

Provide clinical care management services to identified eligible patients, coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care. Works as a member of Interdisciplinary Team (IDT) along with the Ambulatory Care Manager (ACM) and Care Coordinator to ensure the assigned patient’s individual needs are identified and addressed in a timely manner, Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources. 

Essential Job Functions

Essential Functions (7-10) Statements - List the essential functions of the job. Essential functions are the reasons a job exists.

Maintain a caseload of patients according to department policies.

Identify, enroll and manage patients in program for Complex Case Management.

Develop and implement care plans to maximize wellbeing with periodic review and update according to department protocols.

Collaborate with ACM, PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.

Perform situational and family assessment of social determinants of care and develop goals as part of the comprehensive care plan.

Perform patient outreach according to established protocols and document in electronic medical record.

Identify, execute, and track needed referrals to care and community resources.

Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, and right time.

Assist patient in advanced care planning to complete Advanced Directives.

Document all communications with patient and/or care team in electronic medical record.

Perform coordination of services for disabled status and/or facilitate placement in post-acute facility for rehabilitation or long term care.

Act as patient advocate to address primary physical and socioeconomic needs and link patient to appropriate community resources and services.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

Patient Population

The following must be included in all position descriptions that involve direct or indirect patient care.  This is a JCAHO requirement.  Also select  the age of the patient population served:

Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.  

Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures.

Neonates (0-4 weeks)

Adolescents (13-17 years)

Infant (1-12 months)

Adults (18-64 years).

Pediatrics (1-12 years)

Geriatrics (65 years and older)

Not applicable to this position.

Employment Qualifications

Education Qualifications - List the minimum education, training, and experience required to perform the essential functions of the position. 

Required Minimum Education:

Bachelor’s Degree


Social Work

Preferred Education

Master’s Degree


Social Work

Licensing/ Certification - If registration, certification or licensure is required, include the name of the accrediting or licensing body.

Licensure/Certification Required

Master’s Degree or Licensure as required by state of practice

Licensure/Certification Preferred

Case Management certification, LSW or LCSW

Minimum Qualifications

Minimum Years and Type of Experience

2-3 years acute care, home health or case management experience

Other Knowledge, Skills and Abilities Required

Excellent interpersonal communication and negotiation skills. Strong analytical, data management and computer skills. Demonstrate basic knowledge of healthcare and health education across the lifespan in a practice health setting. Ability to work with individuals, groups and families. Familiarity and knowledge of Community Resources. Flexibility to work non- traditional hours. Works well in a Team Setting. Personal computer skills.  Experience with database entry, EMR documentation, Power Point preferred and basic Excel skills.      Highly organized and detail oriented.             Accepts responsibility and follows through on projects and activities

Other Knowledge, Skills and Abilities Preferred

Demonstrated success in improving the health of a distinct population of patients in the ambulatory or community setting

Combination of post-secondary education and experience in lieu of a degree.

V.Working Conditions

This section addresses the physical environment in which the employee will perform the work.

Periods of high stress and fluctuating workloads may occur.

Long-distance or air travel as needed- not to exceed 10% travel.

General office environment.

May be exposed to high noise levels and bright lights.

May be exposed to physical altercations and verbal abuse.

May be exposed to limited hazardous substances or body fluids.*

May be required to use physical restraints.

May be exposed to human blood and other potentially infectious materials.* 

May be exposed to adverse weather conditions; cold, hot, dust, wind, etc.

May have periods of constant interruptions.

Required to car travel to off-site locations, occasionally in adverse weather conditions.

Prolonged periods of working alone.

Other: Click or tap here to enter text.

* Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.

VI.Physical Requirements

Physical Demands






Lifting/ Carrying (0-50 lbs.)

Lifting/ Carrying (50-100 lbs.)

Push/ Pull (0-50 lbs.)

Push/ Pull (50-100 lbs.)

Stoop, Kneel





Work Position




VII.Additional Physical Requirements/ Hazards

Physical Requirements


Select if a physical requirement for this job.

Select if a potential hazard for this job.

Manual dexterity (eye/hand coordination)

Depth perception

Perform shift work

Use of Latex Gloves

Maneuver weight of patients

Exposure to toxic/caustic/chemicals/detergents

Hear alarms/telephone/tape recorder

Exposure to moving mechanical parts

Reach above shoulder

Exposure to dust/fumes

Repetitive arm/hand movements

Exposure to potential electrical shock

Finger Dexterity

Exposure to x ray/electromagnetic energy

Color Vision

Exposure to high pitched noises

Acuity – far

Gaseous risk exposure

Acuity – near

Other: Click or tap here to enter text.

Bon Secours Mercy Healthis an equal opportunity employer.

We’ll also reward your hard work with:

  • Comprehensive, affordable medical, dental and vision plans
  • Prescription drug coverage
  • Flexible spending accounts
  • Life insurance w/AD&D
  • An employer-matched 403(b) for those who qualify
  • Paid time off
  • Educational Assistance
  • And much more

Scheduled Weekly Hours:


Work Shift:



Care Coordination - Population Health Service Organization

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at

Apply Now
Luis F., RN

I wanted to get into a career where I’m happy to go to work.

Luis F. RN
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