Social Worker

Glbhc•Saginaw, MI

13d•Hybrid

About The Position

Coordinates and monitors all MIHP services provided to assigned beneficiaries, including referrals and follow-up. Performs home and office visits, completing assessments and follows according to protocol and providing supportive interventions as deemed necessary based on the assessment. Coordinates participant enrollment and engagement. Participates in interdisciplinary care planning with the MIHP team to develop individualized Plans of Care. Reviews participant needs throughout enrollment and modifies plans as appropriate. Supports participants in identifying barriers to healthy pregnancy and infant development. Promotes participant self-management and informed decision-making. Accepts referrals for patients to address their ongoing needs as the opposite discipline of the Outreach Registered Nurse. Responds according to policy and in a form of communication that is collaborative and reaches the care team effectively. Connects patients with medical and community resources. Maintains knowledge of local community resources and develops collaborative relationships with community partners. Provides and documents referrals as needed to appropriate providers/resources both within and outside GLBHC. Maintains compliance with Medicaid and MIHP documentation standards. Completes and submits all required documentation for client records and complies with billing and record-keeping requirements of the MIHP program. Ensures documentation is accurate, timely, and complete. Maintains participant confidentiality according to HIPAA regulations. Enters required information into the MIHP Database and electronic medical record. Participates in quality assurance, quality improvement and certification activities such as monitoring program outcomes, implementing evidence-based practices, and identifying opportunities to improve participant engagement and service delivery. Conducts outreach and health promotion activities regarding MIHP with healthcare providers and community organizations. Assists with recruitment and retention of eligible participants. Promotes healthy pregnancies, healthy birth outcomes, and infant well-being in accordance with MDHHS MIHP program goals.

Requirements

Bachelor’s in Social Work required.
Licensed as a Limited (LLBSW) or Fully Licensed Social Worker (LBSW).
BLS required.
One year of post-licensure experience providing community health, pediatric, and/or maternal/infant services to families required.
Ability to communicate effectively with a diverse population.
Ability to coordinate patient services and deal effectively with other service organization personnel.
Must have strong decision making and problem-solving skills.
Organized and effective with limited direct supervision.
Ability to provide services in an empathetic, non-judgmental, and objective manner.
Comfortable visiting clients in their homes, and in deteriorated(-ing) and high-risk neighborhoods.
Must be reliable, professional, and culturally competent.
Willing to flex schedule based on patient needs and must be able to work well in a team environment.
Must be able to sit, stand, and or walk for an entire workday.
Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs occasionally.
Extensive travel is required within service area involving the use of company or personal vehicle with reimbursement for mileage provided at the existing rate of the corporation.
Minimal out-of-service area travel may be required in order to attend conferences/trainings.
Must be a licensed driver with proof of personal liability and property damage insurance.

Nice To Haves

Experience working with Obstetric patients, including teenagers preferred.
Knowledge of service area and community resources preferred.
Experience in crisis situation preferred.

Responsibilities

Coordinates and monitors all MIHP services provided to assigned beneficiaries, including referrals and follow-up.
Performs home and office visits, completing assessments and follows according to protocol and providing supportive interventions as deemed necessary based on the assessment.
Coordinates participant enrollment and engagement.
Participates in interdisciplinary care planning with the MIHP team to develop individualized Plans of Care.
Reviews participant needs throughout enrollment and modifies plans as appropriate.
Supports participants in identifying barriers to healthy pregnancy and infant development.
Promotes participant self-management and informed decision-making.
Accepts referrals for patients to address their ongoing needs as the opposite discipline of the Outreach Registered Nurse.
Responds according to policy and in a form of communication that is collaborative and reaches the care team effectively.
Connects patients with medical and community resources.
Maintains knowledge of local community resources and develops collaborative relationships with community partners.
Provides and documents referrals as needed to appropriate providers/resources both within and outside GLBHC.
Maintains compliance with Medicaid and MIHP documentation standards.
Completes and submits all required documentation for client records and complies with billing and record-keeping requirements of the MIHP program.
Ensures documentation is accurate, timely, and complete.
Maintains participant confidentiality according to HIPAA regulations.
Enters required information into the MIHP Database and electronic medical record.
Participates in quality assurance, quality improvement and certification activities such as monitoring program outcomes, implementing evidence-based practices, and identifying opportunities to improve participant engagement and service delivery.
Conducts outreach and health promotion activities regarding MIHP with healthcare providers and community organizations.
Assists with recruitment and retention of eligible participants.
Promotes healthy pregnancies, healthy birth outcomes, and infant well-being in accordance with MDHHS MIHP program goals.
Other duties as assigned by supervisor.