Social Work Case Manager

Medix is looking for a Social Work Care Manager to help us transform the way primary care is delivered and how patients are served. We are partnering with one of the national leader on the forefront of healthcare. We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. This position wil be a hybrid role (onsite/remote).

Schedule: Monday - Friday 8a-5p

Job description

As an extension of the Primary Care Physician's (PCP) care team, Social Work Care Managers are responsible for providing a variety of care management services within a PCP practice(s), a patient's home, or a community setting, targeting physically, socially, and behaviorally complex patients. Social Work Care Managers understand basic pathophysiology of chronic conditions and are comfortable in symptom screening and education, escalating to RNs, PharmD and PCPs when appropriate. Successful patient outcomes require skillsets in Motivational Interviewing, patient engagement and empowerment and coaching/teach-back methods for self-management. Using standard assessments & evidence-based screenings, Social Work Care Managers develop unique patient-centered care plans, collaborating with patient's, their support systems and community service programs.

Responsibilities

• Actively engage and collaborate with PCPs and office staff in identifying at-risk patients
• Employ motivational interviewing skills to elicit optimal patient engagement and outcomes
• Meets with patients and caregivers face to face either in the clinic, or virtually
• Develop deep relationships with patients and their caregivers, serving as a partner to improved quality of life through admission and readmission avoidance
• Perform comprehensive screenings for both physical and psychosocial risk factors combined with data to help inform a wholistic view of patient's status and inform care planning
• Provide brief therapeutic interventions to patients with behavioral health needs, meanwhile connecting them to long term support
• Provide symptom management coaching to patients with medical and social complexities
• Evaluate services and resources provided to patients to determine effectiveness, and modify treatment plan and recommendations as necessary
• Educating patients and caregivers about Advance Care Planning (ACP) and facilitating the in completion of required documents

Requirements

• Master's degree in Social Work
• Licensed Master Social Worker (or state equivalent) with unincumbered licensure in the state of practice or plan to receive licensure w/in 12 months of hire, preferred
• 2+ years of experience in a health care setting. Ideal candidate will have experience working in a Primary Care setting, in/with SNFs, discharge planning, and/or working in a hospital setting performing case management responsibilities
• Experience working with patients with varying physical, behavioral or social complexities preferred.

Medix is acting as an Employment Agency in relation to this vacancy.