New

Social Worker LMSW Care Manager Advanced Heart Failure Ambulatory

Corewell Health
United States, Michigan, Grand Rapids
Nov 06, 2025
About the Department: We are seeking a compassionate and skilled Master of Social Work (MSW) professional to join our Advanced Heart Failure Clinic team. This role plays a vital part in supporting patients and families navigating the complexities of progressive advanced heart failure in pre-transplant care. The MSW will provide psychosocial assessments, counseling support, and resource coordination to optimize patient outcomes and quality of life. As a key member of the interdisciplinary team, MSW collaborates closely with advanced heart failure cardiologists, advanced practice providers, nurse care coordinators, pharmacists, medical assistants and other specialists to address the emotional, social, and practical challenges faced by patients with advanced cardiac conditions. Key Responsibilities: Conduct comprehensive psychosocial assessments for patients with advanced heart failure. Provide supportive counseling and crisis intervention to patients and families. Assist with psychosocial readiness and support planning for potential transplant or ventricular device assist pathway or palliation or hospice care. Facilitate access to community resources, financial assistance, and advance care planning. Participate in interdisciplinary team meetings and contribute to care planning. Advocate for patient needs and promote health equity across diverse populations. Support transitions of care, including discharge planning and outpatient follow-up. Scope of work: To work collaboratively with members of an interdisciplinary team in order to assist patients and families with complex psychosocial needs. These interventions may include, but are not exclusive to: alternate site coordination, discharge planning, addressing all forms of identified abuse/neglect, adoption, substance use disorders, assisting with end of life decisions, providing appropriate referral resources, bereavement support, adjustment counseling, facilitating guardianships and behavioral health concerns (including psychiatric transfers). Conducts psychosocial assessments with patient and or family to assist with identified psychosocial needs or who may be identified to require an alternate site of care post discharge and executes a plan. Communicates with alternate sites of care and/or community agencies in an effective and timely manner, to best address the patient's needs. Completes and documents the assessment and plan in the electronic medical record, accurately reflecting the patient's current condition, situational factors, transition of care needs and psychosocial imperatives. Provides consultation and resources to members of the healthcare team. Responsible for maintaining relevant and current knowledge of community resources. Participates or assists in department, regional, or statewide stakeholder committees, projects etc., as assigned/requested. Develops and maintains current knowledge of federal and state regulations as they pertain to role. Provide short term therapeutic support as appropriate for setting and location. Qualifications: Master's Degree Social Work Required. Master Social Worker (MSW-Master) - State of Michigan Upon Hire Required. 2 years of relevant experience health care related experience post obtaining Preferred. Care management experience Preferred. Experience in individual, family assessment, crisis intervention, grief and loss counseling, and discharge planning preferred. How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - 2902 Bradford St NE - Grand Rapids Department Name Cardiovascular Advanced Heart Failure - GR Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8:00 a.m. to 4:30 p.m. Days Worked Monday to Friday Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447.