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Scheduled Weekly Hours:
0.01Work Shift:
All (United States of America)Essential Job Functions
Maintain a caseload of patients according to department policies.
Identify enroll and manage patients in program for Complex Case Management.
Develop and implement care plans to maximize wellbeing with periodic review and update according to department protocols.
Collaborate with ACM PCPs Specialists and Hospitalists to effectively implement a patientcentered care plan.
Perform situational and family assessment of social determinants of care and develop goals as part of the comprehensive care plan.
Perform patient outreach according to established protocols and document in electronic medical record.
Identify execute and track needed referrals to care and community resources.
Provide resource management to improve care patient experience and reduce unnecessary cost and utilization: right care right place and right time.
Assist patient in advanced care planning to complete Advanced Directives.
Document all communications with patient and/or care team in electronic medical record.
Perform coordination of services for disabled status and/or facilitate placement in postacute facility for rehabilitation or long term care.
Act as patient advocate to address primary physical and socioeconomic needs and link patient to appropriate community resources and services.
This document is not an exhaustive list of all responsibilities skills duties requirements or working conditions associated with the job. Employees may be required to perform other job related duties as required by their supervisor subject to reasonable accommodation.
Education Qualifications
Required Minimum Education: Bachelors Degree Social Work
Preferred Education: Masters Degree Social Work
Licensing/ Certification
Licensure/Certification Required: Masters Degree or Licensure as required by state of practice
Licensure/Certification Preferred: Case Management certification LSW or LCSW
Minimum Qualifications
23 years acute care home health or case management experience
Other Knowledge Skills and Abilities Required
Excellent interpersonal communication and negotiation skills. Strong analytical data management and computer skills. Demonstrate basic knowledge of healthcare and health education across the lifespan in a practice health setting. Ability to work with individuals groups and families. Familiarity and knowledge of Community Resources. Flexibility to work non traditional hours. Works well in a Team Setting. Personal computer skills. Experience with database entry EMR documentation Power Point preferred and basic Excel skills. Highly organized and detail oriented. Accepts responsibility and follows through on projects and activities
Other Knowledge Skills and Abilities
Preferred
Demonstrated success in improving the health of a distinct population of patients in the ambulatory or community setting
MercyHealth is an equal opportunity employer.
Many of our opportunities reward* your hard work with:
*Benefits offerings vary according to employment status.
Department:
Case Mgmt St Ritas Medical CenterIt is our policy to abide by all Federal and State laws as well as the requirements of 41 CFR 601.4(a) 60300.5(a) and 60741.5(a). Accordingly all applicants will receive consideration for employment without regard to race color national origin religion sex sexual orientation gender identity age genetic information or protected veteran status and will not be discriminated against on the basis of disability. If youd like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown Ohio or Bon Secours Franklin Virginia; Petersburg Virginia; and Emporia Virginia which are Affirmative Action and Equal Opportunity Employer please email . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process please contact The Talent Acquisition Team at .
Part-Time