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University of Rochester Social Worker (S) - 225074 in Rochester, New York

Social Worker (S) Job ID 225074


Strong Memorial Hospital

Full/Part Time Full-Time

Favorite Job

Regular/Temporary Regular


Full Time 40 hours Grade 053 Psychiatry SMH Social Work


HR Title: Social Worker, Division of Transitional Care Medicine

Functional Title: Social Worker, CCC Care Management

Description of Patient Population:

Pediatric(s) 5 - 12 X Adult(s) 18 and above (age range) (age range) Adolescent(s) 12 - 18 X Geriatric(s) 65+ (age range)

General Description

The Complex Care Center (CCC) provides interdisciplinary care to adults with pediatric onset conditions including developmental disabilities, sickle cell disease, cystic fibrosis, cerebral palsy, among others. Clinical services at the CCC include primary care, dentistry, physical//respiratory therapies, dietician, and behavioral health. The CCC provides complex and coordinated care through one single point of entry through the engagement of multiple clinical departments and service lines. The Division encompasses the Complex Care Center’s research, training, community service and clinical activities.

The social worker in this role provides social work services to adult patients and their families in the Complex Care Center. The social work services include psychosocial assessments, information and referrals, psychosocial treatment and other services required to optimize the patients' health care. The social worker collaborates with the Complex Care Center health care team, behavioral health providers, and care management programs in the development and implementation of the care plan of patients with whom the social worker is active. The social worker also provides consultation to the Complex Care Center providers regarding patients' care needs and/or community resources.

Major Responsibilities

Administrative (5%):

  • Collaboration with CCC programs of transition care management, nursing care coordination, mental health coordination, and primary care medical home management.

  • Participates in Social Work Division staff meetings.

  • Participates in social work supervision/consultation about his/her work in accordance with plan development with supervisor.

  • Meets with Complex Care administrative leadership as required.

  • Participates in required activities of the Social Work Division and Hospital including, but not limited to, timely completion of statistical reports/forms, time sheets and other Hospital or Division forms; mandatory in-service training programs and University Health Service reviews.

  • Subscribes to the Departmental goal of creating a culturally inclusive environment by treating patient, families, trainees, and co-workers in a sensitive manner with appropriate attention to cultural differences.

  • Participates in available diversity and inclusion events and training appropriate to job duties, and meeting annual training expectations.

  • Attend quarterly meetings with the CCC Community Advisory Board, annual or bi-annual presentation to Advisory Board

Clinical (95%)

+ + Provides direct medical social work care for patients of the Complex Care Center (CCC) in coordination with other CCC care management resources and community supports

  • Provides direct collaborative care coordination support for those undergoing mental health treatment in cooperation with CCC psychiatrist for revolving panel of 15 patients including documentation and billing requirements for care management billing.

  • Performs comprehensive psychosocial needs assessments of patients of the CCC annually.

  • Supports mental health screening of all patients at the CCC

  • Engages with patients that have accessed inpatient or emergency psychiatric services to support discharge planning and engage following the return to the community to prevent recurrent hospital based care.

  • Works collaboratively with crisis services in the community including Mobile crisis and OPWDD service organizations to provide appropriate interventions and follow up based on needs.

  • Provides social work treatment to patients with problems identified through psychosocial assessments. Treatment may include: crisis intervention; supportive counseling; problem solving; information and referral, respite or long-term facility based care; assistance with environmental problems. Services are largely provided within the hospital but may include home or agency visits if required by the patients' needs and situations. Participates in interdisciplinary team meetings to coordinate and optimize patient care plans

  • Engages the patient’s family or other supports in the assessment and treatment process, and where appropriate provides education, support, and/or treatment to the patient’s family/support system.

  • Provides internal and external systems advocacy for patients and families as indicated in care plans.

  • Provides appropriate assessment and intervention services to children and adults suspected of being victims of abuse, neglect and/or domestic violence

  • Documents all patient care activities and interventions in the patient’s medical record in compliance with division policies

  • Provides social work consultation to other clinic care providers regarding patient problems and community services.

  • Provides back-up clinical services as needed during the absence of program staff of other care management resources

  • In special circumstances, makes visits to patients’ homes or community agencies/schools to implement care plans.

  • Performs other duties as assigned

Teaching (NE):

  • Based on experience and as determined by the social work supervisor may supervise social work undergraduate and graduate students. Supervision relates to psychosocial assessment and crisis intervention with patients and family.

Research (NE):

  • The social worker may participate in the development and/or implementation of social work or interdisciplinary research endeavors, as determined by the social work supervisor in consultation with the Social Work Clinical Manager and Chief of the Division of Transitional Care Medicine



A Social Work Division supervisor, licensed by the State of New York (LMSW, LCSW, or LCSW-R), supervises the social worker’s professional performance.


The social worker is accountable administratively and clinically to his/her social work supervisor (and/or Social Work Division Clinical Manager) for the provision of social work services, and adherence to Social Work policies, procedures, and standards of professional conduct. The social worker’s job performance must conform to the expectation set forth in the position description.

The social worker is accountable to the Director of Behavioral Health services at the Complex Care clinic for providing professional services in accordance with the policies and standards established by the program and the Chief of Division of Transitional Care Medicine.


Social work evaluations are conducted annually by the senior social worker’s supervisor, with commentary from the Chief of the Division of Transitional Care Medicine, or a designee. Salary increases and promotional recommendations are subject to guidelines established by the Social Work Division, Strong Memorial Hospital and the University of Rochester.


The social worker who occupies this position must have an MSW from an accredited social work graduate program as well as a New York State license (LMSW or LCSW). Prefer 2 years of social work and community program experience preferred. Applicant must be proficient in use of electronic medical records, conducting formal organizational assessment, data collection and storage, and use of software necessary for compiling relevant metrics for reporting and publication.


The social worker and his /her supervisor review this position description annually. Position review provides opportunity for comment from the Chief of the Division of Transitional Care Medicine and for updating, as needed. Similarly, if a new social worker is hired for the position, a review and update of the position description should occur. Changes in the position description are recommended by the supervisor, in consultation with the Chief of the Division of Transitional Care Medicine. Social Work Division Clinical Manager authorizes any position modification.

Reports to: Social Work Division Manager and Director of Behavioral Health Services at Complex Care Center.

Equipment: Computer, telephone, printer, fax, scanner, copier (multifunction device)


  • Excellent verbal and written communication skills, including the ability to effectively network within and outside the University

  • Ability to access and update medical records

  • Use of software to compile and report on relevant metrics

  • The ability to conduct an organization assessment and develop detailed written proposals

  • Excellent staff management and mentorship skills

  • Strong computer skills, including the ability to use Word, Excel, Access, Adobe, PowerPoint, and other software packages

System Access Requirements

  • Complex Care Center shared drive

  • Netsmart

  • E Record

  • My Path

*For more on the ICARE values go to:

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled