POSITION SUMMARY

The Licensed Clinical Social Worker (LCSW) serves as the Collaborative Care Manager anchoring TEAM VSW's psychiatric Collaborative Care Model and Community Health Integration service lines. Operating within a measurement-based, treat-to-target framework, the LCSW partners with treating providers and the consulting psychiatrist to deliver systematic caseload management, evidence-based brief interventions, SDOH-informed care coordination, and registry-driven outcome tracking for a Medicare Part B population across VSW's service area. This is a heart-led, high-accountability clinical role for a licensed professional who thrives in a collaborative, remote-first care team and is committed to closing gaps in behavioral health access for patients who need it most.

DUTIES & RESPONSIBILITIES

A. Collaborative Care Model (CoCM) Serve as the designated Collaborative Care Manager within the collaborative care team. Administer and score validated screening instruments (PHQ-9, GAD-7, C-SSRS, AUDIT-C, DAST-10, PTSD-5, MDQ) using the VSW Screening Console; interpret results and track patient response over time. Develop, implement, and revise person-centered care plans in collaboration with the treating provider. Maintain and mange the behavioral health registry; conduct systematic, proactive caseload reviews (typically weekly) with the psychiatric consultant. Deliver brief, evidence-based interventions such as Behavioral Activation, Problem-Solving Treatment (PST), and Motivational Interviewing (MI). Support a treat-to-target approach

• stepped-care adjustments, relapse-prevention planning, and escalation of patients not improving as expected.

Track first-month and subsequent-month time thresholds to ensure accurate, compliant CoCM billing. Facilitate warm handoffs, referrals, and follow-up to ensure continuity across the care continuum. B. Community Health Integration Conduct structured SDOH assessments to identify unmet health-related social needs affecting the treatment of the patient's behavioral and/or physical conditions. Develop person-centered plans addressing SDOH barriers, and coordinate practitioner-identified interventions. Navigate and link patients to community resources using VSW's community resource menu and

SOP-VSW-CHI-001

; document linkages and outcomes. Coordinate with community-based organizations and social services to advance whole-person care. C. Registry, Documentation & Measurement-Based Care Maintain accurate, timely documentation in ChronicCareIQ (CCIQ) and Practice Fusion, with fidelity to CMS time-tracking and service-element requirements. Own outcome tracking within VSW's CoCM registry and dashboards, ensuring measurement-based follow-up on every active patient. Generate structured chart notes and communicate status changes promptly to the care team. D. Safety, Compliance & Quality Adhere to

HIPPAA, CMS

documentation and billing requirements, and all VSW clinical SOPs. Executive crisis and safety protocols, including, C-SSRS-driven escalation and coordination of urgent care when risk is identified. Participate in quality assurance / quality improvement (QA/QI) activities, chart audits, and in-service training.

QUALIFICATIONS

Required Qualifications:

Master of Social Work (MSW) from a CSWE-accredited program. Current, unrestricted, independent-practice Licensed Clinical Social Worker (LCSW) credential. Active licensure in at least one VSW service state (IL, IN, WI, HI), with the ability and willingness to obtain additional state licensure as census requires. Minimum two (2) years of post-licensure clinical experience, preferably in integrated / primary-care behavioral health. Demonstrated proficiency with validated behavioral health screening tools and measurement-based cure. Strong EHR and registry documentation skills; comfort working in a remote, technology-enabled care environment.

Preferred Qualifications:

Direct experience in the Collaborative Care Model (CoCM), telehealth behavioral health, and Medicare populations. Formal training in problem-Solving Treatment (PST), Behavioral Activation, Motivational Interviewing (MI), or CBT-informed brief interventions. Multi-state licensure or active pursuit thereof; familiarity with cross-state telehealth practice standards. Bilingual capability and demonstrated cultural humility with diverse patient populations.

CORE COMPETENCIES

Clinical Acumen

• Clinical judgement and crisis assessment Collaboration
• Interdisciplinary teamwork with providers, psychiatry, nursing, and community partners Organization
• Caseload prioritization and disciplined time tracking across concurrent programs Character
• Warmth, cultural humility, and heart-led patient advocacy

WORK ENVIRONMENT & PHYSICAL REQUIREMENTS

Primary remote/telehealth-enabled, supporting patients across Illinois, Indiana, Wisconsin, and Hawaii. Requires a HIPPAA-compliant workplace, reliable high-speed internet, and the ability to work at a computer for extended periods. Occasional coordination with community-based organizations and care-team huddles is expected. Reasonable accommodations will be made to enable qualified individuals to perform the essential functions of the role.

COMPENSATION & BENEFITS

Competitive compensation commensurate with licensure, experience, and program scope, with details discussed during the interview process.

TEAM VSW

is an Equal Opportunity Employer committed to a diverse, inclusive, and heart-led workplace.

Pay:

$20.00

• $25.

00 per hour

Benefits:

401(k) Dental insurance Flexible schedule Health insurance

Work Location:

Hybrid remote in Mount Prospect, IL 60056