Recovery Social Work Care Manager

PCC Community Wellness Center•Chicago, IL

2d•$28 - $31•Hybrid

About The Position

The Recovery Social Work Care Manager is a licensed Social Worker responsible for coordinating screening and providing the intervention of patients with identified complex chronic care needs. Functions in the capacity of a connector between the patient’s needs and the resources provided by PCC’s Austin Recovery Care Center (ARC) and hospitals. Supports whole health outcomes and communicates progress to those in the healthcare organization as well as ensuring the patients receive the best possible care. PCC provides harm reduction and recovery related services to support patients with mental health disorders, and substance use including opiate use disorder and alcohol use disorder. Patients may participate in medication assisted recovery (MAR), behavioral health counseling, and behavioral health group visits. The Recovery Social Work Care Manager (LSW) supports by increasing patients’ self-management skills, reducing patient barriers to participation in ARC programs and with addiction medicine consult (AMC), supporting hospitalized patients, and psychotropic management providing administrative support, as well as supporting patient referrals to higher levels of care. The Recovery Social Work Care Manager (LSW) shows dedication to treating substance use disorder in an interdisciplinary, outpatient and inpatient setting. Provides therapeutic support related to recovery, medical care, behavioral health care, and overall wellbeing to patients in the community, clinic, hospitals, groups, and over the phone. Advocates for patients to insurance payors, inpatient and outpatient treatment facilities, and social service agencies. The Recovery Social Work Care Manager provides consultation and academic support to residents and attending physicians within the ARC, AMC ,Pregnant and Postpartum Women (PPW) and Hepatitis C Program, HIV and psychotropic medication management in the areas of bio psycho social care coordination that may affect overall health outcomes including social determinants of health, substance use and mental health concerns. Closely collaborates with interdisciplinary team including other PCC programs (primary care, etc.) to provide coordinated care for all these patients. Provide comprehensive consultation regarding disease management assessment and mental/behavioral health treatment options to new and established patients to the PCC ARC. Assess patients’ and/or families’ bio-psycho-social situations that include: development issues, family dynamics and stressors, and DSM V diagnoses. Maintain patient registry completing outreach as clinically necessary based on patient social, medical, and behavioral health needs. Communicate and coordinate with payers to ensure coverage of essential medications Identify and follow-up on all referrals made to assure continuity of care and patient/family needs are met. Complete disease specific education as necessary with patient and patient family. Communicate with providers and care team regarding patient progress and care needs. Participate fully in relevant quality assurance and performance improvement measures. Complete home visits, or visits to skilled nursing facility, or hospital as needed and determined by the care team. Participate case consultation as part of the interdisciplinary care team Maintain patient care hours per week at designated site as determined by the Assistant Director of Complex Care and Senior Director of Population Health. Performs other duties assigned per manager discretion to support patients with at the ARC and AMC with Hep C, HIV, Psychotropic and LAI buprenorhine injections. Following PCC workflows, social-work-prepared CM may conduct behavioral health encounters to support specific populations, according to manager assignment. Social-work-prepared CM may support group medical visits, including but not limited to VeggieRx. Social-work-prepared CM may complete additional assessment, clinical, or administrative support for sub-populations and/or funder requests, according to manager assignment.

Requirements

Graduate of an accredited school of social work.
Current and valid CPR certification.
Licensure in the state of Illinois (LSW) required.
Constantly communicates with patients, families, and other healthcare providers.
Must be able to exchange accurate information in these situations.
Demonstrated skills in the designated and certified clinical area of practice arena.
Ability to work and collaborate on a health care team.
Demonstrated ability to effectively and efficiently handle a demanding workload involving multiple tasks.
Proficient in MS Office Business Application to include: Outlook, Word, PowerPoint and Excel.
Ability to read and write proficiently using the English language.
Follow-through, assume responsibility and use good judgment.
Maintain professionalism under stressful situations.
Self-motivated and directed with the ability to prioritize and work efficiently under pressure.
Ability to understand and follow verbal and written communication.
Detail oriented with the ability to work with minimal/no supervision.
Willingness to be part of a team-unit and cooperate in the accomplishment of departmental goals and objectives.
Effective and creative problem solving.

Nice To Haves

CADC-preferred
2 – 3 years clinical experience preferred.
2 - 3 years EMR experience preferred.
LCSW not required

Responsibilities

Coordinate screening and provide intervention for patients with identified complex chronic care needs.
Act as a connector between patient needs and resources provided by ARC and hospitals.
Support whole health outcomes and communicate progress.
Increase patients’ self-management skills.
Reduce patient barriers to participation in ARC programs and with addiction medicine consult (AMC).
Support hospitalized patients and psychotropic management.
Provide administrative support.
Support patient referrals to higher levels of care.
Treat substance use disorder in an interdisciplinary, outpatient and inpatient setting.
Provide therapeutic support related to recovery, medical care, behavioral health care, and overall wellbeing to patients in various settings (community, clinic, hospitals, groups, phone).
Advocate for patients to insurance payors, inpatient and outpatient treatment facilities, and social service agencies.
Provide consultation and academic support to residents and attending physicians within the ARC, AMC, PPW, and Hepatitis C Program, HIV and psychotropic medication management.
Coordinate bio-psycho-social care that may affect overall health outcomes, including social determinants of health, substance use, and mental health concerns.
Collaborate with interdisciplinary teams, including other PCC programs, to provide coordinated care.
Provide comprehensive consultation regarding disease management assessment and mental/behavioral health treatment options.
Assess patients’ and/or families’ bio-psycho-social situations.
Maintain patient registry and complete outreach as clinically necessary.
Communicate and coordinate with payers to ensure coverage of essential medications.
Identify and follow-up on all referrals to assure continuity of care and patient/family needs are met.
Complete disease-specific education as necessary with patient and patient family.
Communicate with providers and care team regarding patient progress and care needs.
Participate fully in relevant quality assurance and performance improvement measures.
Complete home visits, or visits to skilled nursing facilities, or hospitals as needed.
Participate in case consultation as part of the interdisciplinary care team.
Maintain patient care hours per week at designated site.
Perform other duties assigned by manager discretion.
Conduct behavioral health encounters to support specific populations.
Support group medical visits.
Complete additional assessment, clinical, or administrative support for sub-populations and/or funder requests.