Medical Respite Social Worker

• Conduct biopsychosocial assessments within 48 hours of admission to identify patient needs and appropriate referrals.
• Coordinate discharge planning with the medical providers, treatment program specialists, and the Complex Addiction Team (CAT).
• Assist in arranging transportation for discharge.
• Referring to the housing team.
• Maintain accurate and accessible documentation in the medical record, ensuring discharge plans and care coordination are available to the team.
• Build and sustain partnerships with community agencies to support transitions to housing, treatment programs, hospitals, nursing homes, hospice facilities, and other respite facilities.

• Provide supportive counseling, individual therapy as needed, and psychoeducation to address substance use, trauma, chronic illness, grief, and domestic violence.
• Offer mental health crisis intervention, behavioral de-escalation, and emotional support during respite admissions.
• Collaborate with the psychiatry team and nursing to create and implement treatment plans.
• Serve as a resource to staff regarding behavioral health and substance use challenges, supporting a safe and therapeutic milieu.

• Participate in weekly team rounds, weekly behavioral health meetings, and interdisciplinary huddles.
• Support staff in managing patient behavioral issues with empathy and professionalism.
• Coordinate with unit secretaries around transportation to medical appointments.
• Complete PT-1, The Ride, TAP Pass applications with patients as needed.
• Contribute to a team-based model of care that reflects BHCHP’s mission of equity and patient-centered practice.
• Referral to VNA services in collaboration with the medical team.
• Referral to DMH services.

• MSW/LICSW/LCSW/LMHC (must obtain licensure within 18 months [LCSW] or 42 months [LMHC]).
• Minimum 2 years of experience in behavioral health, substance use treatment, or medical social work.
• Experience with unhoused and complex adults is strongly preferred.
• Prior hospital or medical setting experience providing intensive case management preferred.
• Strong clinical skills in assessment, counseling, crisis intervention, and behavioral de-escalation.
• Knowledge of psychiatric and substance use disorders, trauma-informed care, and community resources.
• Ability to navigate local shelter systems and entitlement benefits.
• Excellent documentation and teamwork skills.
• Experience with EHR systems.
• Proficiency in multiple languages is preferred.
• Excellent communication, interpersonal, and organizational skills; capable of working effectively in a fast-paced team environment.

• The compensation ranges from $66,000 - $105,600 annually and increases based on years of experience.
• BHCHP full time employees are eligible for our competitive time off program, health, dental and vision insurance, 403B retirement savings plan, pre-tax MBTA pass program with 40% discount, additional compensation for demonstrated bilingual proficiency and more. Benefits are prorated for part-time employees.

Does this amazing opportunity interest you? Then we'd love to hear from you.

As an equal opportunity employer, Boston Health Care for the Homeless Program is committed to providing employment opportunities to all qualified individuals and does not discriminate on the basis of race, color, ethnicity, religion, sex, gender, gender identity and expression, sexual orientation, national origin, disability, age, marital status, veteran status, pregnancy, parental status, genetic information or characteristics, or any other basis prohibited by applicable law.

Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.

Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.

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