LCSW LMSW - CARE MANAGER

• Full Time Permanent Position
  
• 3-4 Days of Home Visits (within an hours drive in the assigned territory) and 1-2 Days of Telehealth
  
• 4 Patients/ Day for Home Visits
  
• 6 Patients/Day for Telehealth
  
• Coordinating Services not providing direct therapy
  
• Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care.
  
• This position will work with underserved populations
  
• Monday Friday, 8AM-5PM (Exceptions when patients request a visit after 5PM)
  
• This position will work with underserved populations.
  
• 1-Week Training in company headquarters in Nashville (All-Expense Paid)
  
  

Responsibilities

• Perform in-home care management visits to assess and impact social and behavioral status
  
• Work closely with Care Team to ensure continual progress on all care management goals
  
• Assess social determinants of health needs and develop a plan for addressing them
  
• Perform behavioral, environmental and social support assessments and surveys as needed
  
• Deliver individual, family and group education on living with chronic illness
  
• Engage family and social support groups in the education and care of patients
  
• Assess patients and refer to behavioral health specialists if diagnosis and treatment needed
  
• Help patients to understand, accept and follow medical and lifestyle recommendations
  
• Serve as the point of contact for patient questions regarding social and behavioral
  
• Facilitate conversations around and consideration of proactive care decisions, especially relating to transplantation, home modalities and AV fistula placement
  
• Initiate patient relationships through enrollment and onboarding processes
  
• Review and document patient updates and progress in care management platform.
  
• Identify, vet and build relationships with local Community-Based Organizations
  
• Introduce patients to appropriate resources and act as the patient advocate
  
• Serve as subject matter expert on social determinants for other members of the Care Team
  
• Occasionally visit patients or take call remotely on some nights and weekend
  

Requirements

• Master s Degree in Social Work, behavioral sciences or another related field
  
• Currently licensed as a LCSW or LMSW in the state of Arizona
  
• 2+ years previous experience working in care management and/or with chronic illness within a medical environment i.e. home health, dialysis, hospice
  
• Ability to visit patients occasionally or take calls remotely on some nights and weekends
  
• Ability to show empathy and quickly build relationships with patients and local Community-Based Organizations (CBO)
  
• Excellent verbal communication skills both in person and on the phone
  
• Ability to work with Microsoft Office and mobile phone and web-based applications
  
• Self-starter with the ability to work independently with minimal supervision
  
• Prior experience or interest in working with a start-up
  
• Ability to travel to company main location in Nashville for training.
  
• Fluency in Spanish a plus