Social Work Care Coordinator (Broadway Family Medicine)

University of Minnesota Physicians•Minneapolis, MN

20d•Onsite

About The Position

University of Minnesota Physicians Broadway Family Medicine Clinic is committed to setting the standard for excellence in health care delivery for you and your family. We see newborns, children, teenagers, adults, seniors, and people living in nursing homes. Our clinic offers services in family medicine, obstetrics and gynecology, social services, patient education, and referrals to specialty care. We are a Certified Health Care Home and offer enhanced care coordination services. What you will do as a Social Work Care Coordinator: Works with the clinic’s health care team to provide direct patient care through assessment and referrals to appropriate community, governmental, or social service programs Engages in population health strategies and participates in panel management Completes the Care Coordination process for clinic team’s patients including: Referrals, hospital discharge coordination, working with providers to complete Care Plans as necessary, creating goals with patients and follow-up with the patients on goal setting and other duties for care coordination Advocates for patients by evaluating obstacles to medical care at the clinic Works with PCS, Physicians and other staff in the health care home environment to remove any barriers to receiving excellent, cost effective care Collaborates with, and delivers information to appropriate community organizations Participates in the development and implementation of policies and procedures for the Social Worker position working in the health care home setting Participates in faculty, resident and new employee orientation/education Demonstrates ability to deliver care or service adjusting approaches to reflect developmental level of population served

Requirements

Bachelor’s degree in Social Work required
Minnesota Social Work licensure required
2-4 years of experience in Social Work within healthcare setting
Proven track record to work effectively with diverse patient population
Ability to understand and stay current with community, governmental and social service programs available to patients

Responsibilities

Works with the clinic’s health care team to provide direct patient care through assessment and referrals to appropriate community, governmental, or social service programs
Engages in population health strategies and participates in panel management
Completes the Care Coordination process for clinic team’s patients including: Referrals, hospital discharge coordination, working with providers to complete Care Plans as necessary, creating goals with patients and follow-up with the patients on goal setting and other duties for care coordination
Advocates for patients by evaluating obstacles to medical care at the clinic
Works with PCS, Physicians and other staff in the health care home environment to remove any barriers to receiving excellent, cost effective care
Collaborates with, and delivers information to appropriate community organizations
Participates in the development and implementation of policies and procedures for the Social Worker position working in the health care home setting
Participates in faculty, resident and new employee orientation/education
Demonstrates ability to deliver care or service adjusting approaches to reflect developmental level of population served