Medical Social Worker - Candler Road Clinic

Location: Candler-McAfee Shopping Center, Decatur, GA 30032
Schedule: Monday-Friday, Day Shift (No nights or weekends)

Grady Health System is proud to expand outpatient care with the launch of our new Candler Road Clinic, conveniently located in the Candler-McAfee Shopping Center with easy access to public transportation (MARTA). This new neighborhood health center will provide primary, preventative, and specialty care with a strong focus on community wellness and care accessibility.

We are hiring a dedicated Medical Social Work Care Manager to support patients in navigating their care journey, addressing social determinants of health, and ensuring safe, supported transitions after clinical visits.

The Medical Social Work Care Manager collaborates with Clinical Care Coordinators (C3s), providers, and interdisciplinary teams to coordinate high-quality care for patients and ensure their needs are met across the care continuum. From initial assessment to discharge planning, this role helps patients overcome barriers, access community resources, and experience seamless transitions in care.

This is a vital role in our integrated outpatient care model-providing social support, counseling, and advocacy to patients and families.

• Conduct psychosocial assessments of patients and families to identify needs related to mental health, social support, financial challenges, housing, transportation, food insecurity, and safety.
• Provide crisis intervention, supportive counseling, and referral to behavioral health and community resources as needed.
• Collaborate with physicians, nurses, case managers, and other clinic staff to support treatment planning and continuity of care.
• Develop care plans to address social determinants of health and monitor progress toward goals.
• Educate patients and families about available community resources, entitlement programs, and support services.
• Facilitate referrals to substance use treatment, domestic violence services, and other specialized care programs.
• Advocate for patients to ensure equitable access to healthcare and community-based supports.
• Assist with discharge planning, follow-up coordination, and reduction of avoidable hospital admissions.
• Document all patient interactions, assessments, interventions, and outcomes in the electronic medical record in accordance with organizational and regulatory standards.
• Participate in clinic team meetings, case conferences, and quality improvement initiatives.
• Provide health education workshops and support groups as appropriate.
• Maintain professional knowledge through continuing education and adherence to ethical standards of social work practice.

• Master's Degree in Social Work (MSW) - Required

• Licensed Medical Social Worker (LMSW) - Preferred

• Case Manager Certification (CCM or ACM) - Preferred

• Prior experience in social work, discharge planning, or care management - Preferred

• Previous experience in a clinic or ambulatory setting is a plus

• Serve in a newly opened clinic focused on accessibility, prevention, and wellness

• Work in a community-centered environment with reliable weekday hours

• Help reduce health disparities by providing critical support to vulnerable populations

• Join a collaborative team with shared goals for patient success and system efficiency

Grady Health System is an Equal Opportunity Employer.