Job Description
SUMMARY:
Seeking a compassionate and experienced Licensed Master Social Worker (LMSW) to provide skilled social work services to adult and geriatric patients in a home health setting. The LMSW will support patients and caregivers by conducting comprehensive psychosocial assessments, coordinating community resources, assisting with care planning, and addressing social, emotional, and safety-related needs that impact health outcomes.
This position requires strong clinical judgment, excellent communication skills, and the ability to work independently while collaborating with an interdisciplinary care team. The selected candidate will provide services throughout East Portland and surrounding areas.
Key Responsibilities
· Perform comprehensive biopsychosocial assessments of patients and caregivers.
- Conduct initial evaluations and develop individualized plans of care.
- Establish, monitor, and revise patient-centered goals based on changing needs.
- Provide counseling, emotional support, and crisis intervention when needed.
- Assist patients and families with discharge planning and transition of care.
- Coordinate services with healthcare providers, community agencies, and internal teams.
- Educate patients and caregivers regarding available resources, healthcare planning, and support services.
- Assist with access to community-based programs, financial resources, and healthcare benefits.
- Provide support related to advance directives, guardianship, power of attorney, and protective services.
- Identify high-risk patients experiencing vulnerability, safety concerns, or complex social barriers.
- Maintain accurate documentation of assessments, interventions, patient responses, education, and care coordination activities.
- Participate in interdisciplinary care conferences and collaborative care planning.
Required Qualifications:
· Active LMSW/LCSW license.
- Must hold both Oregon and Washington social work licensure.
- Minimum 1–2 years of professional social work experience.
- Skilled Home Health experience required.
- OASIS experience required.
· Experience working with adult and geriatric populations.
· BLS (AHA)
Any Specific Mandate skill required
· Epic/Epic Remote Client documentation experience
o Adult Protective Services
- Guardianship and Power of Attorney
- Advance Directives
- Medicare/Medicaid resources
- Home and Community-Based Services (HCBS)
- Community support programs
HL01
Pay: $2,200.00 - $2,400.00 per week
Application Question(s):
- • Do you currently hold active Social Work licensure in both Oregon (OR) and Washington (WA)?
- • How many years of skilled Home Health social work experience do you have, and do you have hands-on OASIS documentation experience?
Work Location: In person
