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SDOH Lead- LMSW preferred
Company : Essen Health Care
Location : Bronx, NY, 10451
Job Type : Full Time
Date Posted : 1 January 2026
Overview
Company Overview: At Essen Health Care, we care for that!
As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program.
Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!
Job Summary
Position Title: SOHD Lead/ Licensed Master Social Worker preferred
Reporting to: House Calls Division (Social Determinants of Health Dept)
Job Summary: The SOHD Lead will provide in-home social work services to individuals who are managing chronic illness, recovering from surgery, or dealing with other life-limiting conditions. This role will involve collaborating with medical teams, supporting patient and family needs, and advocating for resources to improve patient outcomes and quality of life.
This person will be responsible to perform daily social work operations in office and on the field for House Calls. Driver will be provided
Responsibilities
- Develop and lead an SDOH program for House Calls
- Train and oversee Community Health Workers
- Collaborate with physicians, nurses, and other health professionals to create a holistic care plan.
- Connect clients with community resources such as housing assistance, healthcare services, and food programs.
- Provide individual and family counseling to patients dealing with chronic illness, mental health issues, or the challenges of aging.
- Offer emotional support to patients and families, addressing mental health needs and adjustment to medical conditions or lifestyle changes.
- Provide education to clients and their caregivers on managing health conditions and navigating available support systems.
- Participate in multidisciplinary team meetings to discuss patient progress, concerns, and adjustments to the care plan.
- Offer insights regarding the psychosocial aspects of the patient's care, contributing to a holistic treatment approach.
- Maintain accurate and timely documentation of patient assessments, care plans, and progress notes in compliance with organizational policies and healthcare regulations.
- Ensure all documentation is aligned with privacy regulations (HIPAA) and other relevant guidelines.
Qualifications
- Education: Master's Degree in Social Work from an accredited institution.
- Licensure: Active Licensed Master Social Worker (LMSW) license in New York State.
- Experience: Experience in behavioral health, social work, or related fields is often preferred.
- 2-5 years experience managing a team
- Skills: Strong communication and interpersonal skills, ability to work independently, and proficiency in electronic health records.
- Transportation: Driver will be provided
- Bilingual Abilities: Proficiency in additional languages, such as Spanish, may be preferred.
Equal Opportunity Employer
ESSEN HEALTH CARE IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER
Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.
Bronx, NY
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Frequently asked questions
A SDOH Lead focuses on addressing social determinants impacting health, coordinating in-home care, and leading community health workers. Unlike traditional social work, this role integrates clinical collaboration with direct patient support in diverse Bronx communities, emphasizing resource advocacy and holistic care plans tailored to chronic illness management.
Effective communication, cultural competency, and the ability to mentor community health workers stand out. A Licensed Master Social Worker here must blend clinical insight with operational oversight, guiding multidisciplinary teams while fostering a collaborative environment that supports vulnerable populations in the Bronx.
In addition to an active LMSW license, obtaining certifications in population health, case management, or trauma-informed care can enhance expertise. These credentials align well with the integrated, community-focused approach Essen Health Care employs, potentially unlocking advanced leadership roles.
The Bronx has a growing demand for skilled social workers specializing in social determinants of health due to its diverse, underserved communities. While competition exists, candidates with leadership experience and bilingual skills, especially Spanish, find strong opportunities at organizations like Essen Health Care.
Bronx’s traffic congestion and public transit variability can complicate daily travel. Essen mitigates this by providing a driver for house calls, easing fieldwork logistics and allowing the SDOH Lead to focus on patient care without transportation stress.
Essen’s commitment to accessible, holistic care means the SDOH Lead is pivotal in bridging clinical services with social support. This role ensures patients’ social needs are met alongside medical treatment, embodying Essen’s model of care coordination across multiple specialties and community programs.
Essen’s extensive multispecialty network and house calls program distinguish this role. The SDOH Lead benefits from integrated clinical divisions, access to over 400 practitioners, and a strong emphasis on innovative, patient-centered approaches within a culturally rich urban setting.
The typical compensation for an SDOH Lead in the Bronx with an LMSW license ranges between $70,000 and $85,000 annually. This reflects local market rates for social work leadership roles that combine field operations and clinical collaboration in healthcare organizations like Essen Health Care.
Essen encourages continuous learning through training on population health strategies and offers leadership mentorship. The organization’s diverse clinical environment provides ample opportunities to develop skills in interdisciplinary teamwork, community resource navigation, and social health program innovation.
This role uniquely combines in-home patient assessments, team leadership, and coordination with physicians and nurses. The SDOH Lead also oversees community health workers, ensuring social support services are integrated effectively into chronic illness management and holistic treatment plans.