Social Worker- Care Management
Company: Central Ohio Primary Care
Location: Westerville
Posted on: May 8, 2024
Job Description:
Central Ohio Primary Care Physicians is seeking a Care Manager,
Social Worker to join our Comprehensive Care team located in
Westerville, OH. The Care Manager, Social Worker works closely with
Physicians, Nurse Care Managers, Pharmacists, and other care team
members to provide and develop plan of care. Responsibilities
include assessing and managing transition plans for patients who
are at high risk for readmission for social, psychological and/or
environmental needs related to the impact of admission, diagnosis,
treatment, and discharge. This position receives referrals from
across the network of Physicians, working closely with transition
of care Nurses and Nurse Care Coordinators to identify high-risk
patients who are appropriate for disease or care management
programs. The Care Manager, Social Worker is responsible for
identifying and understanding community-based resources and
connecting patients with these resources as needed. This is full
time position working Monday- Friday 8a-5p.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
- Complete patient assessments to evaluate all social,
psychological, or environmental needs related to the impact of
admission, diagnosis, treatment, or discharge.
- Provide patient/caregiver with education, information, and
referral services. Provide patient/caregiver with relevant
information about medical illness, behavioral health, insurance
coverage, support, and community services.
- Develop plan of care for patients in collaboration with the
primary care team. Document in the medical record as indicated and
designated case management tool accurately.
- Perform Face-to-Faces as necessary including home, office and
skilled rehab facility settings . Evaluate possible barriers to
attainment of self-management goals and develop strategies to
overcome.
- Provide ongoing communication between the patient and health
care team to ensure improved patient outcomes and high quality of
patient care. Conduct end-of-life discussions with patient/family,
as needed.
- Facilitate referrals to other disciplines and internal health
and community based programs as needed to improve patient outcomes.
Coordinate and participate in interdisciplinary patient/caregiver
conferences.
- Participate in departmental process improvement initiatives,
work on special projects as needed and attend all departmental
meetings.
- Serve as an advocate and resource for the
patient/caregiver.
- Provide temporary case management to a specified case load.
QUALIFICATIONS:
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.
A. Experience, Education, Licensures & Certifications
- Required: Five years or more clinical and care management
experience in hospital, home health/hospice, or managed care
setting
- Required: Licensed Social Worker in the state of Ohio
- Preferred: Master's degree in Social Work B. Knowledge, Skills
& Abilities
- Proficient in computer software and usage including but not
limited to Microsoft Outlook and Microsoft Excel
- Knowledge of community resources and behavioral needs for adult
population
- Knowledge of trends in healthcare, managed care, Medicaid, case
management, medical management and quality improvement
- Demonstrate awareness and ability to work alongside diverse
cultures and patient populations
- Ability to create positive working relationships with
physicians and other members of the health care team
- Ability to demonstrate work toward the progress of patient-
centered goals
- Ability to adapt to changing environment
- Ability to work independently and within a team environment
with minimal supervision
- Excellent negotiation and advanced conflict resolution
skills
- Strong analytical, organizational, and time management
skills
- Strong written and verbal communication skills; ability to
communicate effectively in stressful situations
- Self-disciplined, energetic, passionate, and innovative
- Decision making/problem solving and training/teaching
skills
- Critical and 'systems' thinker with strong attention to
detail
Keywords: Central Ohio Primary Care, Dayton , Social Worker- Care Management, Executive , Westerville, Ohio
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