MSW Care/Case Manager

CenterWell Home Health • Tampa, FL

91d • $59,300 - $80,900 • Hybrid

About The Position

Become a part of our caring community and help us put health first. The Field Care Manager, Behavioral Health 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Field Care Manager, Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Working within an interdisciplinary care team, the Care Navigator is responsible for proactively engaging patients identified as high-risk and implementing targeted interventions to address social needs and increase access to care. The Care Navigator will provide guidance and oversight of care coordination efforts to other members of the team, and handle clinical escalations as indicated. This role requires an understanding of how socio-economic stressors can impact ability to engage in healthcare and subsequent health outcomes. Experience will ideally include prior work with patients with behavioral health diagnoses, as well as in navigating local community-based resources and benefit applications. This role has a mobile presence, involving travel to patients' homes, treatment facilities and community-based settings, and assigned clinics to facilitate and foster connections.

Requirements

• Master's in Social Work (MSW)
• Minimum of 4 years of experience working in healthcare services and navigating community-based resources

Nice To Haves

• Strongly prefer Bilingual Spanish/English
• Familiarity with state Medicaid guidelines and application processes preferred
• Experience working with patients with behavioral health conditions and substance use disorders preferred
• Prior experience conducting home visits and knowledge of field safety practices preferred

Responsibilities

• Conduct Transitions of Care Management for a subset of the patient population, including ER and hospital follow ups
• Provide triage guidance and supportive consultation to other team members, handling escalated complex cases
• Develop care plans leveraging 5Ms Geriatric best practice framework
• Develop a wholistic view of patient needs related to Social Determinants of Health
• Identify existing barriers to engagement with necessary resources and supports
• Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support
• Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems
• Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team
• Supporting patients' self-determination, motivate patients to meet the health goals they have identified
• Refer patient to necessary services and supports
• Lead Interdisciplinary Team Meetings when indicated
• Assess patient's family system, and conduct family meetings with patient and family when needed
• Participate in creation and facilitation of team training content
• Conduct group psychoeducation and support groups within the Center
• Perform all other duties and responsibilities as required
• Participate in and lead interdisciplinary review of and coordination around complex patients
• Maintain patient confidentiality in accordance with HIPAA
• Document patient encounters in medical record system in a timely manner
• Follow general policies related to fire safety, infection control and attendance

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Master's degree