Lyon-Martin Community Health Services

Bilingual

• 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
• 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
• Assist patients with scheduling appointments, arranging transportation, interpretation access, and navigating the healthcare system
• Provide and coordinate referrals and assist with the completion of paperwork to ensure access to appropriate wraparound services
• 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
• Develop safety plans with patients in crisis
• Maintain open communication with the care team to ensure patient safety and well-being throughout and after the crisis
• Participate in weekly Case Management Team Meetings to discuss patient care and improve health outcomes
• Engage in professional development to stay informed on best practices in case management, crisis intervention, and patient care

Clinical Social Worker – Licensed/Associate, Spanish Bilingual