Job Description

Nature of Work

This position provides the social service component of the medical home for Children with Special Health Care Needs (CSHCN). The incumbent works closely with multidisciplinary teams—including medical, legal, and community service providers—to ensure comprehensive care coordination for clients with complex health conditions, including all foster children. This role requires frequent statewide travel, strong communication, and a high level of professional integrity, particularly regarding client confidentiality and collaboration.

Key responsibilities include:

• Collaborating with nurses, social workers, child protective services, courts, law enforcement, physicians, nutritionists, and other specialized providers.
• Leading, developing, and coordinating individualized assessments and care plans for each CSHCN client.
• Reassessing client social service needs through clinic visits, home or face-to-face interactions, and regular review of records and reports.
• Documenting all contacts with clients and families and ensuring copies are shared with the state file and relevant staff.
• Traveling frequently throughout the state to support clients and assist peers in other regions.
• Representing the CSHCN program in advisory committees, task forces, and meetings.
• Providing transition services within the medical home as needed.
• Participating in training to maintain licensure and improve job performance.
• Handling client information with the utmost confidentiality to ensure HIPAA compliance.
• Maintaining clear communication with all CSHCN staff involved in client care and sharing case information as needed.
• Enhancing understanding of the CSHCN program among human service providers.
• Following all responsibilities outlined in the CSHCN Policy and Procedure Manuals.
• Assisting Child Protective Services in court hearings related to CSHCN cases.
• Working with clinic staff to deliver optimal social services to CSHCN clients and foster children.
• Discussing social service, educational, and health care compliance needs with clients and families.
• Supporting appropriate referrals to Child/Adult Protective Services and other WV Department of Health or local social service programs.

Minimum Qualifications

Training: Bachelor's degree in Social Work from an accredited college or university.

Substitution: Bachelor's degree in Sociology, Psychology, Counseling, Criminal Justice, Behavioral Science, Interpersonal Communications, Human Services, Education, Special Education, Elementary Education, or Secondary Education from an accredited college or university may be substituted for the degree in Social Work

OR

current West Virginia Social Work License.

Special Requirement: Eligible for Temporary Social Work License OR Licensed as a Social Worker, Graduate Social Worker, or Certified Social Worker by the West Virginia Board of Social Work Examiners.

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