The Social Worker coordinates a comprehensive patient care plan with the Nashville Babies Strong team including the PI/Medical Coordinator, Program Manager, providers and staff. The Nashville Strong Babies Project is a comprehensive case management and care coordination approach for women and infants at greatest risk for experiencing a poor perinatal outcome.

• Provide patient assessment according to project protocol. Conduct home visit with participants. Help create each participant individual care plan. Schedule additional visits with high risk patients. • Provides direct patient follow-up care in collaboration with the OB/GYN and Pediatric Providers. • Provides adherence counseling; monitors patient adherence to program plans; follow-up on patient adherence to counseling based on identified need and acuity. • Provides patient education in conjunction with OB/GYN and Pediatric Provider. • Serves as a principal liaison between patients and medical providers; coordinates and follows clinic referrals, appointments and educational classes. • Develop collaborative approach to service delivery through integration of activities and services across all programs and projects. • Develop new resources and relationships with outside service providers. • Work with the Program Manager and key staff to develop and conduct quality assurance processes for client/site records • Performs other related duties as assigned.

Required Skills

• Knowledge of clinical psychology • Knowledge to foster excellent patient relationships • Ability to work independently, take initiative, prioritize duties and work closely with other programs/projects. • Organized, detail-oriented and have the ability to handle a variety of tasks simultaneously with a problem-solving approach. • Skills working effectively with clients from diverse backgrounds, with sensitivity provided to people from diverse communities. • Literacy and experience with Microsoft Office programs. • Excellent written, verbal and telephone skills. • Sensitivity to patient needs and cultural competence • Knowledge of the healthcare environment • Strong interpersonal and communication skills and supervision skills and the ability to work effectively with a wide range of constituencies in a diverse community and within the program. • Records maintenance skills.

Required Experience

• LCSW required

• Knowledge of clinical psychology • Knowledge to foster excellent patient relationships • Ability to work independently, take initiative, prioritize duties and work closely with other programs/projects. • Organized, detail-oriented and have the ability to handle a variety of tasks simultaneously with a problem-solving approach. • Skills working effectively with clients from diverse backgrounds, with sensitivity provided to people from diverse communities. • Literacy and experience with Microsoft Office programs. • Excellent written, verbal and telephone skills. • Sensitivity to patient needs and cultural competence • Knowledge of the healthcare environment • Strong interpersonal and communication skills and supervision skills and the ability to work effectively with a wide range of constituencies in a diverse community and within the program. • Records maintenance skills.