Social Worker 2

Job Title: Social Worker 2

Requisition ID: 65433

Client: Tennessee Department of Health (TN DOH)

Department: TDOH-CHS-SERO

Work Location: Hybrid 1301 Riverfront Parkway, Suite 209 Chattanooga, TN 37402

Contract Duration: April 6, 2026 - June 30, 2026

Work Schedule:

Monday - Friday

8:00 AM - 4:30 PM (EST)

7.5 hours per day

Expenses: Allowed

Job Overview

The Social Worker 2 will be part of the Clinical Care Team, supporting primary care providers and patients by addressing social determinants of health (SDOH) such as housing, food insecurity, transportation, and access to healthcare resources.

The role involves coordinating care, connecting patients to community resources, assisting with referrals, and supporting case management activities to improve patient outcomes.

Key Responsibilities

Social Determinants of Health Support

• Provide social needs screening and assessments for patients referred by providers or nurses
• Assist patients with accessing community resources such as housing, food, clothing, and mental health services
• Compile and maintain a resource directory including eligibility requirements, referral processes, and contact information
• Collaborate with healthcare providers, nurses, and other social workers to identify appropriate resources

Case Management

• Assist hospitals with discharge planning and follow-up care coordination
• Help obtain patient medical records from hospitals and specialists
• Assist patients in securing necessary medical equipment through community partners
• Follow up on care plans and patient treatment needs
• Identify patients who are overdue for care or lost to follow-up and assist them in reconnecting with services

Referral and Care Coordination

• Assist with specialty referral coordination, including scheduling and tracking imaging or specialist appointments
• Maintain referral resource lists including eligibility criteria, costs, and contact details
• Support patients in accessing low-cost prescription options and patient assistance programs
• Assist with applications for programs such as CoverRx and RxOutreach

Documentation and Patient Support

• Document patient interactions and updates in medical records
• Provide patient education and direct patients to appropriate educational resources
• Tag providers and clinical staff in patient records when follow-up is required

Additional Responsibilities

• Complete onboarding and orientation requirements
• Participate in regional office and clinical meetings as requested
• Attend provider meetings and community health council meetings
• Build relationships with community service agencies
• Identify barriers to care and work with teams to develop solutions

Tools & Equipment

• Personal computer
• Telephone
• Fax machine
• Printer, scanner, and copier
• Calculator
• Personal vehicle for community coordination activities