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Clinical Social Worker - Care Coordination, Addiction Medicine - LCSW/ LICSW

Bicycle Health is a Telehealth-based medical group specializing in the care of patients with opioid use disorder utilizing MAT (Medication for Addiction Treatment) integrated with psychosocial support. We seek licensed Social Workers with experience providing clinical care for individuals struggling with opioid use.

This position requires management of a panel of patients of varying levels of need in close coordination with an addiction medicine provider. Our Social Workers perform psychosocial needs assessment and develop treatment plans for new patients, stratify the assigned panel by need, then deliver case management, care coordination, therapy, and counseling services. Time will be divided between direct services to patients and administrative responsibilities further described below.

Case Management/Care Coordination

  • Coordinate care between patients, Bicycle Health providers, patients’ primary care providers and other specialty mental health services to facilitate effective patient-centered, team-based care.
  • Document all care coordination and patient encounters in the EHR and provide timely updates to multi-disciplinary team members.
  • Research and facilitate referrals to community services and additional treatment programs based on patient need.
  • Assist patients in need of higher levels or care, specialty mental health or substance use services, outside of primary care, to connect with appropriate treatment resources.

Clinical Support/Population Health Management

  • Address patients' concerns particularly during early treatment and periods of instability, track treatment response, and answer questions related to the treatment process.
  • Collect psychosocial health history and collaborate with the medical provider to develop a treatment plan for new patients.
  • Utilize standardized, evidence-based clinical measures to assess patients' symptoms and response to treatment.
  • Evaluate and/or revise care plans with appropriate documentation in progress notes and communicate updates to relevant multi-disciplinary team members.
  • Systematically track treatment response, outreach efforts, and clinical outcomes using a registry/task management system.
  • Participate in weekly team huddles with providers and other members of a patient’s care team.
  • Provide brief individual and/or group-based treatment using evidence-based interventions such as motivational interviewing, behavioral activation, problem-solving treatment, and CBT.
  • Develop and implement group programming for patients with co-occurring disorders.
  • Lead staff training to enhance awareness and competencies in providing safe, effective, and compassionate care for patients.
  • Assist with individual and group supervision of MSW interns.

Required:

  • Licensed in the State of Texas (LCSW)
  • Master’s Degree in Social Work from an accredited graduate-level program.
  • Minimum 1-year experience providing direct care for individuals diagnosed with addiction, including individual and group-based psychotherapy.
  • Proficiency in Motivational Interviewing, Behavioral Activation, Problem-Solving Treatment, and Cognitive Behavioral Therapy.
  • Available to work one evening per week.

Preferred:

  • Bilingual English/Spanish.
  • Experience with population health management, including registry-based tools.
  • Interest in program development and quality improvement initiatives.

Benefits:

  • Competitive compensation and benefits package.
  • Talented and fun coworkers who are passionate about addiction treatment.
  • Opportunity to make a difference in patients’ lives, and gain experience working in healthcare.
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