Care Manager Social Worker - Oncology Services

Frederick Health•Frederick, MD

1d•Onsite

About The Position

Frederick Health is seeking a full-time Care Manager Social Worker for our Oncology Services. This is a Monday to Friday 8am to 4:40pm or 8:30am to 5pm role. The Care Manager Social Worker works collaboratively with medical providers and healthcare professionals within Frederick Health and across the healthcare continuum. Professional social work skills are utilized to assess for unmet social needs, provide information and referrals to appropriate resources, psychosocial assessment, counseling support, and establishing plans for management of identified needs in the acute and/or ambulatory setting. Assessment, planning, interventions, and reassessment are performed within a collaborative and interdisciplinary team. The Care Manager Social Worker will also assist with patient/family navigation through the healthcare continuum, while focusing on improving quality outcomes and ensuring appropriate utilization of resources through effective care management practices.

Requirements

Graduation from an accredited school of social work with a Bachelors or Master’s degree in social work with a current Maryland license.
Three to five years of care management and/or healthcare experience.
Certified in Cardiopulmonary Resuscitation (CPR) - not applicable for employees working in an approved, full time remote position.
Completes Maryland Board of Social Work continuing education (CEU) requirements to ensure licensure is in good standing.
Demonstrates effective interpersonal and communication skills, including superb customer service skills.
Strong organizational and time management skills.
Excellent critical thinking skills, ability to work in a fact pace team environment, ability to multi-task, ability to adapt well to change and take on new challenges/projects, ability to effectively communicate and collaborate with physicians and staff.
Ability to apply creative problem-solving skills to complex situations.
Knowledge of clinical and psychosocial aspects of patient care.
Community resource knowledge.
Ability to work independently and interdependently.
Personal creditability and the ability to serve as both a patient advocate as well as being committed to the health system goals.
Upholds social work values, ethical principles, ethical standards.
Demonstrates skills in planning, organizing, and managing multiple functions and complex processes.
Knowledge of basic computer software programs.

Nice To Haves

Master’s Degree preferred.
Care Management certification preferred including but not limited to Accredited Case Manager (ACM) certification.

Responsibilities

Delivery of care coordination within Frederick Health which may include hospital or ambulatory site assignment.
Performs psychosocial assessment and planning to develop the plan of care to address identified needs.
Identification of barriers to care including but not limited to socioeconomic status, unmet social needs, impaired coping, support network dysfunction.
Promotes and values diversity to promote inclusive working relationships.
Communication with interdisciplinary care team, patients, and families.
Promotes coordination with healthcare professionals.
Monitors and evaluates care management plans.
Provides education.
Possesses working knowledge of regulatory components of assigned healthcare setting.
The Integrated Care Management- Care Manager Social Worker will work collaboratively with physicians, staff, and other healthcare professionals within ambulatory Frederick Health Medical Group practices and/or community practices that participate in the clinically integrated network (CIN)- Frederick Integrated Healthcare Network (FIHN).
Care coordination will focus on requirements of various value-based care contracts and population health focus areas.
Transitions of care, risk stratification data, and provider/care team referrals will initiate care management within this population.
The Care Manager Social Worker will interpret data to evaluate and implement care management strategies and interventions related to attributed beneficiaries and patient populations.
Optimizes patient wellness through the promotion of self-management strategies.
Telephonic, medical office, and home visits will be conducted.
The Transitional and Chronic Care Management (TCCM) Social Worker will work collaboratively with the TCCM clinicians, community programs and Frederick Health Hospital case managers.
Social worker will focus on patient needs to ensure a healthy environment in their home and to be able to age in place as the goal.
Work with FHH case managers on patients with contracts who DC to the community to ensure timely follow-up and make plans for when contract ends.
Telephonic and home visits will be conducted.
Behavioral Health Social Worker will concentrate on managing patients needing assistance with mental health and substance abuse issues to ensure optimal outcomes for the patients in the community.
The Comprehensive Care Center (CCC) Care Manager works collaboratively with practice providers, staff, and other healthcare professionals to provide care coordination across the healthcare continuum.
The social worker will assist the patient and their family in identifying barriers to medical care and helping to implement solutions and is responsible for connecting patients to required medical services and community resources.
The social worker assists CCC patients in navigating the healthcare continuum while improving the coordination of care focused on enhancing quality outcomes while ensuring appropriate utilization of resources through effective care management practices.
CCC SW will proactively identify opportunities to improve the patient and family experience of care and improve the efficiency and effectiveness of resource use.
The SW Care Manager, in partnership with physicians, nursing and healthcare team members, utilize professional skills to screen for and assess patient and family needs for care coordination, discharge/transition planning, risk stratification and psychosocial needs.
The SW Care Manager role also includes proactive, individualized planning for patients’ progress across the continuum that optimizes quality of care, patient satisfaction, and utilization and reimbursement to meet organizational strategic objectives.