Social Work Care Manager

Cincinnati Children's•Mount Vernon, VA

1d•$74,298 - $94,744•Onsite

About The Position

This role involves providing comprehensive care management services to patients and their families. The Social Work Care Manager will conduct psychosocial assessments, manage resources, provide psychosocial interventions, and collaborate with interdisciplinary teams to ensure optimal patient well-being and adherence to treatment plans. The position focuses on empowering patients and families, advocating for their needs at a systems level, and ensuring effective coordination of care to minimize fragmentation of services.

Requirements

Bachelor degree in a related field.
5+ years of work experience in a related job discipline.
LISW licensure required.

Nice To Haves

Master's degree in Social Work

Responsibilities

Conduct comprehensive psychosocial assessments to identify patient/family strengths, challenges, and needs, determining eligibility for care coordination.
Stratify patients to match needs with appropriate and cost-effective care coordination models.
Utilize advanced interviewing and therapeutic skills to address abuse, neglect, and safety risks, reporting suspicions to mandated authorities.
Complete accurate and clear documentation of assessments and interventions.
Partner with patients/families to obtain financial assistance, community resources, and specialized equipment.
Develop resource networks, effectively utilize resources, and serve as a peer resource.
Provide accurate, real-time information on available resources and condition-specific support.
Identify needs, develop programs, and evaluate outcomes for special populations, implementing changes based on results.
Facilitate collaboration with community agencies to enhance investigation and intervention processes.
Advocate for patient populations on a systems level by developing programs and protocols.
Educate patients and families to recognize progress and identify changes needed in the treatment plan.
Provide psychosocial services as outlined in the patient's care plan.
Offer supportive counseling to maximize emotional coping and treatment adherence.
Facilitate timely and effective collaboration with referral sources and the healthcare team.
Educate patients/families and healthcare team members on evidence-based treatment options.
Provide self-management support to high-risk/complex patients/families to manage chronic conditions.
Motivate and empower patients/families through anticipatory guidance and planning to reduce discharge barriers.
Initiate and facilitate family-centered care team meetings.
Demonstrate a therapeutic approach focusing on micro and macro systems, including crisis intervention.
Promote patient/family/caregiver well-being through system improvement initiatives.
Act as a liaison between patients/families, the medical team, and outside agencies.
Mediate within the medical team on behalf of patients/families.
Empower patients/families to problem-solve by exploring care options and alternative plans.
Develop processes for effective communication and coordination within the healthcare team, involving patients/families in decision-making.
Facilitate communication and coordination between healthcare team members, including medical homes and community services.
Attend and lead care conferences.
Ensure communication of key plan components and patient needs to subsequent providers, ensuring safe handoffs.
Ensure the healthcare team integrates health information and communicates summaries to build caregiver skills and foster relationships.
Demonstrate understanding of legal and regulatory issues impacting care delivery and reimbursement (HIPAA, EMTALA, etc.).
Negotiate and advocate for necessary patient services and resources.
Provide patient/family education on post-acute services and community resources.
Create an environment that supports patient safety by integrating safety goals into daily practice.