Medical Social Consultant (Care Coordinator)

University of Illinois Chicago•Chicago, IL

7h•Hybrid

About The Position

The Medical Social Consultant (Care Coordinator), also described as the DSCC Home Care Coordinator (Consultant), provides care coordination to families eligible for the Division of Specialized Care for Children (DSCC) Home Care program. The program serves Medicaid non-waiver participants under age 21 and people eligible for the Persons who are Medically Fragile, Technology Dependent (MFTD) waiver program. The role builds partnerships with enrolled families through monthly interactions, comprehensive assessments, person-centered care plans, and coordination with multiple stakeholders. The position works under the direction of a regional manager and may manage clinically or socially complex cases, including situations involving neglect or abuse allegations, illness progression, caregiver hardship, or complex behavioral health needs. It collaborates with families, providers, agencies, and internal care coordination staff, and contributes to quality improvement and program compliance. Illinois residency is required within 180 days of employment.

Requirements

Master’s degree from an accredited school or university in social or behavioral science or a related health specialty area.
Either current Illinois licensure as a Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW), based on institutional requirements, or three years (36 months) of progressively responsible full-time social work experience in a medical/clinical or social service agency setting.

Responsibilities

Complete comprehensive health assessments, identify family strengths, and develop person-centered service and care plans.
Ensure participants and/or legally responsible adults understand waiver services, their estimated frequency, and provider types.
Monitor person-centered care plans every 30 days or as needed; assess status changes, prioritize unmet needs, and locate resources.
Promote interagency collaboration with HFS, DCFS, and other community or state agencies involved in participant care.
Educate, support, and connect non-waiver families with resources for age transitions, and provide transition support to waiver families leaving the program due to health improvement.
Complete timely documentation, generally within 48 hours, to meet waiver and non-waiver renewal requirements and timelines.
Conduct and document in-person visits at home or other appropriate settings, such as schools or hospitals, every six months or as needed under federal waiver requirements.
Manage clinically and socially complex cases that may involve neglect or abuse allegations, illness progression, caregiver hardship, or complex behavioral health needs.
Use interpreter language-line and accommodation resources as needed, including American Sign Language, in accordance with university ADA guidelines.
Use a culturally competent approach that supports families’ cultural values and traditions.
Arrange, lead, and contribute expertise to multidisciplinary care team meetings with providers, family members, nursing agencies, or school teams.
Partner with team members, including home care liaisons and nurse consultants, to facilitate transitions of care.
Identify and escalate participants with complex behavioral, social-determinant, or clinical factors affecting well-being, and facilitate internal team meetings.
Identify critical incidents and collaborate with involved parties to resolve them.
Participate in post-record reviews and complete recommended remediation within expected timelines.
Contribute to quality improvement initiatives, including attending quality huddles and providing recommendations as needed.
Support other licensed and unlicensed care coordinators in verifying and interpreting clinical conditions, treatments, mental or behavioral health concerns, care-plan priorities, and resource recommendations.
Assist families with private and public health insurance through benefits management practices.
Comply with University, Division, and Regional Office policies and procedures.