Care Manager Social Worker - Clinical

Company: St Joseph Hospital
Location: Hesperia
Posted on: May 3, 2021

Job Description:

We are looking for a Care Manager Social Worker for SMHDMG Clinical QM at St. Joseph Heritage Healthcare.Location: Hesperia, CAWork Schedule: Full Time - 80 Biweekly HoursShift: 8-hour, DaysJob Summary:The goal of the Care Manager, Social Worker is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The Care Manager Social Worker utilizes the following processes to meet the patient's individual healthcare needs: assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care. The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission vision and core values of St. Joseph Health.Essential Functions:* Assessment: The Care Manager Social Worker will collect in-depth information about a persons' situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient's needs. The Care Manager Social Worker will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient's well-being. This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations.* Planning: The Care Manager Social Worker will identify specific objectives, goals and actions, as identified during the assessment process. Acting as a patient advocate the Care Manager Social Worker will collaborate with the physician, the patient & family, and members of the healthcare team, to formulate a shared plan of care. Goals and time frames for goals, appropriate to the patient, will be set.* Implementation: Executes specific interventions that will lead to accomplishing the goals and time frames of the shared plan of care, Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process.* The Care Manager Social Worker will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.* Coordination: Organizes, coordinates, provides, modifies or obtains appropriate authorizations, utilizing appropriate utilization review and evidence of coverage guidelines, to accomplish the patient's goals. Initiates and communicates with the patient and family, physicians, healthcare members, and community and payor representatives. Facilitates continuity of care throughout all access points involving Health Plan, discharge planners, physicians and other appropriate staff.* Monitoring: Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and services provided. Manages a caseload of high risk, complex needs and/or catastrophic patients.* Evaluation: At appropriate and repeated intervals, assesses and reassesses the patients' progress. If progress is static or regressive, determines the reason and encourages the appropriate interventions to obtain optimal outcomes. The Care Manager Social Worker will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.* Communication: Communicates both verbally and electronically with the patient and the healthcare team. Appropriately documents the plan of care, outcomes, statistical reporting, logs, and files abiding to departmental, legal and regulatory requirements.Skills:* Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system required.* Proficiency in Milliman (MCG) Care Guidelines preferred.* Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum.* Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way.* Excellent interpersonal, verbal and written communication skills.* Ability to problem-solve.* Ability to access and evaluate community resources to meet patient's needs.* Ability to handle multiple tasks at a time and remain organized.* Ability to work autonomously but demonstrates the ability to work collaboratively on a team.* Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities.* Excellent computer and IT system knowledge.* Possesses the knowledge and skills necessary to communicate with third party payers.* Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner.Minimum Position Requirements:Education: Master's Degree in Social Work, Psychology, Counseling or Master's Degree with five (5) years relevant social work experience.Experience:* Six (6) months Clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting.* Three (3) years Utilization management and/or case management highly desirable.Licenses/Certifications:Valid California driver's license.Automobile insurance for employee-owned vehicles.Preferred Position Qualifications:Experience:* Psychiatric chemical dependency treatment.* Managed care experience.Licenses/Certifications: Certification in Case Management (CCM, ACM)Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Associated topics: case, clinician, coordinator, field, forensic, msw, outreach, rww, tirr, youth

Keywords: St Joseph Hospital, Hesperia , Care Manager Social Worker - Clinical, Other , Hesperia, California