About Job
Licensed Independent Clinical Social Worker (LICSW)
Position Summary:
MFM Health is seeking a compassionate, proactive, and resourceful Social Worker to join our integrated Primary Care team. In this role, you will work collaboratively with our Nurse Care Manager and medical providers to support high-risk patients by addressing social determinants of health, facilitating care coordination, and enhancing patient outcomes through resource navigation and outreach.
What We Offer:
- Enhanced Benefits Package: Enjoy a comprehensive benefits package that includes discretionary paid time off to ensure a healthy work-life balance and a 401(k) plan with employer match.
- Professional Growth Environment: At MFM Health, we are committed to your professional development. We offer continuous opportunities for learning and career advancement in a supportive and collaborative environment.
Key Responsibilities:
- Assess and address social determinants of health impacting patients’ well-being, such as housing instability, food insecurity, transportation, financial stress, and access to care.
- Connect patients and families with appropriate community resources including public assistance programs, support groups, housing services, and behavioral health services.
- Conduct post-discharge outreach to patients recently released from hospital or inpatient care to ensure continuity of care and successful transitions.
- Provide emotional and practical support to patients and families facing significant life changes, including chronic illness, disability, aging, or caregiver burden.
- Support resource navigation by helping patients understand and access complex systems including insurance, public programs, and social services.
- Assist with care coordination by collaborating with the Nurse Care Manager and providers to ensure timely implementation of specialty referrals and follow-up care.
- Bridge the gap between medical and social care, ensuring that care plans are responsive to both clinical needs and social realities.
- Maintain accurate documentation in the electronic health record (EHR) and participate in team-based care meetings.
Qualifications:
- Master’s Degree in Social Work (MSW) from an accredited institution; LCSW or equivalent state licensure preferred.
- Minimum of 2 years of experience in a healthcare, primary care, or community-based setting.
- Strong understanding of social determinants of health and experience with vulnerable or high-risk populations.
- Knowledge of local community resources and social service agencies.
- Excellent communication, organizational, and interpersonal skills.
- Ability to work both independently and collaboratively in a fast-paced, team-based environment.
- Proficiency with electronic health records and case management tools.
Preferred Experience:
- Experience working in a primary care or interdisciplinary care team setting.
- Familiarity with motivational interviewing or trauma-informed care approaches.
Salary Range
- $80K - $92K
About MFM Health
Our mission at MFM Health is to Make Lives Meaningfully Better. We are continually expanding our practice to provide quality, comprehensive, and compassionate care to patients on the North Shore and beyond. We are committed to hiring passionate individuals who are motivated to succeed in a collaborative, patient-centric culture. We pride ourselves on our commitment to excellence, offering services 365 days a year, drive-thru healthcare, and on-site specialty teams and ancillary services.
At MFM Health, we offer excellent benefits, top-notch training, and a vibrant work environment. We believe in celebrating our employees' successes and regularly gather for company-wide parties and events to foster strong team connections. Join us as we continue to grow, investing in our people, programs, and technology to deliver legendary patient service and further our reputation as the provider, practice, and employer of choice!
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Professional Field

