LCSW - Primary Care

We are looking for an LCSW to provide behavioral health care for our patients at the Community Clinic Primary & Specialty Care - Holly Street in Siloam Springs, AR. This professional would also rotate to the clinic in Gentry, AR 1 day per week. The position is full-time, exempt, and has a Monday-Friday schedule with no nights or weekends.

The Licensed Certified Social Worker (LCSW) – Primary Care, is an integral member of Community Clinic's interdisciplinary primary care team.

Within a Primary Care Behavioral Health (PCBH) model, the LCSW provides evidence-based behavioral health assessment, brief therapeutic interventions, crisis support, and care coordination.

Working with primary care providers (PCPs), psychiatric providers, and other members of the health care team, the LCSW helps patients address behavioral health concerns that affect their overall health, functioning, and quality of life; identifies psychosocial barriers to health; supports behavior change; and connects patients to additional services when indicated.

The role emphasizes accessible, patient-centered, trauma-informed, and culturally responsive care, and applies independent clinical judgment within the scope of licensure, organizational policies, and applicable state and federal regulations.

Essential Job Functions

• Function as an embedded member of the primary care team, integrating behavioral health services into routine medical care and supporting coordinated, whole-person care with PCPs, psychiatric providers, nursing staff, and other clinical personnel.
• Participate in interdisciplinary case consultations and help develop individualized, patient-centered care recommendations that reflect the connection between physical health, mental health, substance use, and social determinants of health.
• Conduct focused behavioral health assessments for patients presenting with mental health, substance use, emotional, behavioral, and psychosocial concerns, including symptoms, stressors, functional impairment, social history, and factors affecting treatment engagement.
• Assess risk related to suicidal ideation, self-harm, harm to others, substance use, and other acute concerns, and identify the appropriate level of care: brief intervention, ongoing treatment, psychiatric consultation, or specialty referral.
• Provide clinical impressions and treatment recommendations to the primary care team within the scope of licensure and clinic protocols.
• Provide brief, focused, evidence-based interventions, generally 20–30 minutes, consistent with the PCBH model, using approaches such as motivational interviewing, behavioral activation, solution-focused brief therapy, ACT-informed interventions, cognitive and behavioral strategies, and problem-solving techniques.
• Help patients build coping skills, emotional regulation, resilience, and achievable behavioral health goals, supporting anxiety, depression, adjustment difficulties, stress, grief, sleep disturbances, and other common concerns through trauma-informed, culturally responsive, strengths-based practice.
• Determine when brief primary care interventions are appropriate and facilitate referrals for longer-term or specialized psychotherapy when indicated.
• Accept same-day behavioral health referrals from PCPs and other clinical team members whenever feasible, and conduct warm hand-offs that engage patients, address immediate concerns, and minimize barriers to follow-up care.
• Provide timely assessment and intervention for patients experiencing acute emotional distress, suicidal ideation, or other behavioral health crises, including suicide and safety risk assessments and safety plans in accordance with clinical standards and organizational protocols.
• Coordinate follow-up, consultation, emergency evaluation, or higher levels of care when clinically indicated, collaborating with PCPs, psychiatric providers, emergency services, and community resources, and document crisis assessments, interventions, decisions, and disposition in the electronic health record.
• Evaluate psychosocial factors that affect health outcomes, including housing instability, food insecurity, financial hardship, transportation barriers, interpersonal difficulties, family stressors, and limited access to community resources, and help patients address them.
• Connect patients with community resources, social services, specialty mental health providers, and other support systems; coordinate referrals and follow-up to promote continuity of care and reduce gaps in treatment; and advocate for patient access to care.
• Collaborate with psychiatric providers on behavioral health evaluation and treatment planning, including biopsychosocial assessments and psychiatric intake workflows as assigned.
• Provide behavioral health support to patients in the Medication-Assisted Treatment (MAT) program, including identifying psychosocial barriers and recovery-related needs, using motivational interviewing and relapse-prevention strategies, coordinating with the MAT team, and facilitating referrals to substance use treatment and recovery support.
• Support patients in addressing behavioral and psychosocial factors tied to chronic conditions such as diabetes, hypertension, chronic pain, and insomnia, including medication adherence, self-management, and lifestyle change (smoking cessation, weight management, stress reduction, sleep, and substance use reduction), in collaboration with PCPs.
• Participate in developing, implementing, and refining clinical pathways for depression, anxiety, chronic pain, insomnia, and substance use, and support standardized screening, assessment, intervention, referral, and follow-up processes.
• Maintain accurate, timely, concise documentation in the electronic health record, including assessments, interventions, risk evaluations, treatment recommendations, referrals, and follow-up plans, in accordance with clinic policies and professional standards.
• Maintain patient confidentiality and comply with HIPAA/HITECH and applicable HRSA, CLIA, NCQA PCMH, OSHA, and other regulatory and accreditation requirements, as well as Arkansas social work licensure requirements, professional ethical standards, and Community Clinic policies.
• Participate in quality improvement initiatives that evaluate patient outcomes, access to care, service utilization, and the effectiveness of integrated behavioral health services, and assist with tracking clinical measures.
• Participate in team meetings, case consultations, staff education, and interdisciplinary training, and maintain professional knowledge through continuing education, consultation, supervision when required, and ongoing professional development.
• Champion Community Clinic's mission & values with patients, colleagues, and the community.
• Perform other duties as assigned that are consistent with the position, qualifications, and scope of practice.

Measures of Success (KPIs)

• Access: same-day referral and warm hand-off response, time to first behavioral health visit, visit volume and caseload
• Clinical Quality: timeliness and appropriateness of assessments and interventions, completion of risk assessments and safety plans, depression and anxiety screening and follow-up measures
• Documentation: timely, accurate, and complete clinical documentation
• Collaboration and Care Coordination: PCP and psychiatric team collaboration, referral completion and follow-up, patient engagement
• Compliance: adherence to professional, ethical, legal, and regulatory requirements
• Quality Improvement and Professional Growth: participation in quality improvement initiatives, case consultation, and continuing education

Community Clinic Essential Competencies

• Service: Treats every patient and coworker with empathy, respect, and a genuine desire to help.
• Ownership: Takes responsibility for their actions, follows through on commitments, and upholds high standards even when no one is watching.
• Adaptability: Remains flexible, open to change, and willing to learn in order to meet the evolving needs of our patients, teams, and organization.
• Collaboration: Works together with openness and respect, shares information freely, and supports co-workers to provide seamless, high-quality care.
• Problem Solving: Approaches challenges with curiosity, finds practical solutions, and takes initiative to improve processes and patient experiences.

Role Specific Essential Skills/Competencies

• Clinical Social Work Expertise: Knows mental health assessment, psychosocial evaluation, brief psychotherapy, crisis intervention, safety planning, and care coordination. Identifies the behavioral, psychological, and social factors affecting physical health, treatment adherence, and functioning, and recognizes when a patient needs additional evaluation, specialty treatment, or a higher level of care.
• Integrated Care and Collaboration: Works effectively within an interdisciplinary primary care team. Consults and communicates well with PCPs, psychiatric providers, and other health care professionals, and gives concise clinical recommendations that support timely, coordinated care.
• Clinical Judgment and Patient Engagement: Applies independent clinical judgment within the scope of LCSW licensure and organizational protocols. Builds therapeutic rapport quickly in brief encounters using motivational interviewing, strengths-based approaches, trauma-informed care, and culturally responsive practice, with sensitivity to diverse cultural, socioeconomic, and psychosocial backgrounds.
• Organization and Efficiency: Manages a varied, potentially high-volume caseload in a fast-paced primary care setting. Balances patient encounters, documentation, care coordination, and team consultation, and prioritizes clinical needs and same-day referrals.
• Technology and Documentation: Proficient in electronic health records and standard office technology. Maintains accurate clinical documentation and complies with organization