Social Work Case Manager II

Chase Brexton Health Care-posted 3 months ago
Mid Level
Glen Burnie, MD
251-500 employees
Hospitals
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Responsible for providing a wide range of social work and medical case management services to CBHS patients and families, with the goal of addressing social determinants of health that directly impact access to and engagement in medical care and treatment. Service delivery shall include all or many of the following: patient screening, comprehensive psychosocial assessment, service or care planning, referral and linkage to resources, progress monitoring and reassessment, crisis intervention, and supportive counseling. As a member of the medical care team, Social Workers provide consultation and support regarding concrete needs and financial services to CBHS providers and patients. Additionally, Social Workers facilitate applications for Social Security, Medicaid and Medicare programs, and Affordable Care Act enrollment. Social Work services are made available to primary care, obstetrics/gynecological, pediatric, dental, behavioral health, LHRC, and infectious disease patients, who present with 1) general level of needs requiring routine follow-up and monitoring; 2) specialized or targeted needs requiring a specific, responsive, skilled intervention; or 3) complex needs requiring moderately intensive monitoring and follow-up services.

  • Provides supportive counseling for patients and families as per CBHC policy.
  • Performs comprehensive intake assessments and completes all necessary documentation duties.
  • Completes assigned triage and clinic duties in thorough, timely, and accurate manner.
  • Provides wide range of social work case management and outreach services to patients and families.
  • Case management includes comprehensive assessments, linkage to resources, planning, monitoring, crisis intervention, supportive counseling, and coordination with other team members.
  • Executes aspects of assigned departmental or organizational plans specific to the provision of care and services to a diversity of patient populations.
  • Facilitates psycho-educational and social/clinical support groups, as necessary for targeted CBHC patients.
  • Demonstrates advanced level of knowledge about existing community resources and how to access those resources that improve social determinants of health.
  • Coordinates information, caseload priorities, and referrals.
  • Follows up on referrals in a timely, accurate manner.
  • Completes referrals in a timely and accurate manner.
  • Reviews patient needs, acuities, care plan, and engagement through periodic case consultation with supervisor.
  • Works with providers, the health care team, and the community.
  • Educates providers, the health care team, and the community about medical case management services through in-services and verbal or written communication.
  • Participates in interdisciplinary team meetings and staff meetings as appropriate.
  • Provides consultation to medical providers, other CBHC staff, and other service providers to facilitate a coordinated continuum of care.
  • Ensures documentation is accessible to the patient's care team and considers that they may be accessible to the patient.
  • Ensures care plan is updated addressing medical case management needs.
  • Maintains accurate data for reporting to funders and partners.
  • Develops relationships and collaborates with appropriate community resources.
  • Documents all services as directed by CBHC policy, State requirements, and professional standards.
  • Adheres to departmental and policy and procedures.
  • Demonstrates appropriate use of billing, grant or orders coding for all EHR documentation.
  • Utilizes Electronic Health Record to support and improve integrated healthcare.
  • Demonstrates ability to engage patients and/or families who are not engaged in services through outreach and follow up.
  • Refers and creates linkage for patients with resources provided within the CBHC service delivery system, as well as appropriate community based resources.
  • Participates in outreach activities, events, trainings, and networking and educational opportunities as appropriate.
  • Master's Degree in Social Work.
  • Active Maryland State Social Work License (LGSW, LCSW, LCSW-C) as specified and required for Ryan White grant.
  • MHBE Insurance Assister/Counselor Certification within one year of hire.
  • Three years of related experience in a health care setting and Community, case management, and/or outreach experience.
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