Social Worker II - CMHRP

Nash County•Nashville, NC

36d•Hybrid

About The Position

This position provides Care Management services to Nash County residents to improve outcomes and reduce medical costs. The Nash County Health Department is a public health agency that provides services in conjunction with the North Carolina DHHS. The primary purpose of this position is to deliver pregnancy care management services that improve birth outcomes in the North Carolina Medicaid population and thereby reduce costs. The pregnancy care managers, working with the DHB network, provide a variety of services in the form of population management and direct pregnancy care management.

Requirements

Social workers with a Bachelor of Social Work (BSW, BA in SW, or BS in SW) or Master of Social Work (MSW, MA in SW, or MS in SW) from a Council on Social Work Education (CSWE) accredited social work degree program.
Registered nurses
Bachelor's degree in a human service field with 5 or more years of care management/case management experience working with the specific population of low-income, pregnant individuals and/or children ages 0 to 5 years
Bachelor’s degree in a human service field with 3 or more years of care management/case management experience working with the specific population (low income, pregnant individuals and/or children ages 0 to 5 years and has certification as a Case Manager (CCM preferred)
Valid North Carolina Driver's License.
Considerable knowledge of social work principles, techniques, and practices and their application to individual casework, group work, and community problems.
Knowledge of the psychosocial, socioeconomic and behavioral problems and their treatment.
Knowledge of governmental and private organizations and community resources.
Knowledge of laws, regulations, and policies which govern the program.
General knowledge of medical terminology, disease processes and their treatment is required in certain programs or settings.
Skill in establishing rapport with a client and applying techniques of assessing psychosocial, behavioral, and psychological aspects of client’s problem.
Ability to help patients obtain assistance in many areas, including financial and housing needs; to adjust to sometimes extreme psycho/social pressures is essential.
Proven skills in counseling.
Ability to communicate effectively and maintain good rapport with patients and their families.
Demonstrate good judgement and reasoning abilities.
Handle all contacts with the public in a courteous, professional and prompt manner.
Coordinate services with community agencies, medical centers, physicians, etc.
Follow infection control guidelines and be adequately immunized according to agency’s employee health policy.
Maintain patient confidentiality.

Nice To Haves

Certification as a Case Manager (CCM preferred)

Responsibilities

Utilize targeted data and referrals to identify patients who may benefit from pregnancy care management.
Engage pregnant and postpartum women with priority risks.
Complete clear documentation of the pregnancy assessment, conditions/needs, interventions, goals and other pregnancy care management activities.
Complete all documentation online in Virtual Health.
Maintain on-going contact with local physicians and community agencies that provide medical care and services to pregnant and postpartum women in order to promote referrals for Care Management for High Risk Pregnancy.
Assist in identification of pregnant and postpartum women who potentially meet the target population criteria.
Serve as the Care Manager for Medicaid eligible pregnant and postpartum women residing in Nash County following State DHB, PHP and DHHS guidelines.
Perform outreach, population identification, assessment and risk stratification, interventions based on plan of care and referrals as indicated, integration with health care providers (Medical Home), collaboration with the local Prepaid Health Plan network, and enter required data in Virtual Health.
Provide care management services in accordance with the approach outlined in the Care Management for High Risk Pregnancy Standardized Plan.
Facilitate client/family in accessing appropriate services within the community.
Assess psychosocial, nutritional (WIC referral), medical, educational and financial needs using Pregnancy Home Risk Screening forms and Comprehensive Needs Assessment.
Counsel regarding the importance of early prenatal and continuous prenatal care.
Counsel patients on the importance of keeping all appointments and following medical/nursing recommendations.
Maintain good rapport with other agency staff as well as other service providers in the community.
Serve as liaison with local physicians, Home Health, local hospital, Department of Social Services, and Regional High Risk OB clinic.
Continuously update knowledge and skills in the area of Maternal, Child Health and Public Health.
Serve on appropriate committees which focus on infant mortality and other issues which affect clients (Supervisor approval is required).
Attend trainings, educational activities, and monthly staff meetings.
Be an active member of the Care Management Team and participate in monthly meetings with CMHRP staff, providing input in ongoing caseload to ensure quality and continuity of care.
Participate in disaster services as required.
Assist with department wide community activities (ex. Flu clinics, health fairs) as needed.
Represent the Agency in court only when subpoenaed to testify.
Other duties as assigned by the Social Work Supervisor and/or Health Director.
Assess the patient, family and environment.
Develop a care plan.
Provide counseling and education.
Make referrals and follow-up.
Monitor needs.
Serve as an advocate for the patient.
Serve as a liaison with other service providers.
Attend job-related workshops when appropriate.
Promote CMHRP by attending speaking engagements upon invitation.