Case Manager Outpatient - SW - WellStar Health System : Job Details

Case Manager - Social Worker

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

The Case Manager - Social Worker will:

• Work in conjunction with a team of Nurse case managers, Social Workers, Registered Dietitians, Pharmacists, Physicians, Leadership of Population Health Management, and other members of the care team across the continuum of care.
• Conduct comprehensive assessments, create plans of care, implement, monitor, and evaluate options and services required to meet an individual's complex health care related needs.
• Coordinate services to set up any identified patient need.
• Serve as a consultant to other RN Case Managers and Care Team Members and make recommendations to assist with adequately meeting patient psychosocial/mental health needs.
• Connect with patients in person, on the phone and through email, in the hospital, and in the physician's office.
• Collect and track data and make recommendations for improvements with the team and across the system.

Core Responsibilities and Essential Functions:

Assessment

• Conduct comprehensive assessment of patients needs, gaps in care.
• Communicate and collaborate with multidisciplinary team on patients mental health and psycho/social needs.
• Communicate effectively with patients and their families.
• Proficient in negotiating complex systems to effect positive change.
• Follow patients over time and continuously evaluate the plan of care for effectiveness. Adjust as appropriate.

Planning

• Consult with physicians, nurses and multidisciplinary professionals.
• Instructing other health care professionals as to the nature of the patients social or psychological challenges to help them in their treatments as well.
• Knowledgeable regarding Medicaid/Medicare and other payer programs to guide patients and families.
• Knowledgeable regarding recognizing and reporting abuse and neglect. Ability to guide the rest of the care team on completing these processes.
• Provides guidance to members seeking alternative solutions to specific social, cultural or financial problems that impact their ability to manage their healthcare needs.
• Keep detailed treatment records, data tracking and documentation. Evaluate for trends and make suggestions for improvement.

Implementation/Evaluation

• Demonstrates understanding of community resources and refers to agencies as appropriate to patient need.
• Create a comprehensive inventory of local community and government resources for patients and their families. Facilitate the patients access to these resources.
• Form relationships and works constructively with other community service professionals.
• Makes referrals to and completes placement process to skilled nursing facilities, HH, DME, Hospice, drug and alcohol rehabilitation as appropriate.
• Manages behavioral and psychosocial needs that result in improved clinical and financial outcomes and delivers social work interventions.
• Facilitates and coordinates behavioral health resources as individual member needs are identified.
• Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
• Evaluates members' ability to independently manage self and locate alternative resources when limitations are identified via standardized Social Work Psychosocial evaluation methods, processes and tools while maintaining accurate record of activities.
• Other duties as assigned

Required Minimum Education:

• Masters Social Work

Required Minimum License(s) and Certification(s):

• LCSW - Lic Clinical Social Worker GA or LMSW - Lic Master Social Worker GA
• BLS - Basic Life Support or BLS-I - Basic Life Support - Instructor

Required Minimum Experience:

• Minimum 3 years experience as a social worker in an acute care setting or community-based organization.
• Previous experience with managing a comprehensive case load and working as part of a client care team.
• Knowledgeable regarding long-term care facilities, hospice, Georgia Medical Care Foundation, DFACS, SSA, managed care and insurance companies philosophies and principles along with various health delivery systems including acute, post-acute and community based.
• Expertise in managing complex patient populations, transitions in care, placements, abuse and neglect reporting and community resources.
• Excellent verbal and written communication skills.

Required Minimum Skills:

• Computer Proficiency with MS office suite and working with excel spreadsheets.
• Skill in identifying problems and recommending solutions.
• Skill in preparing and maintaining records and written reports.
• Exceptional communication skills, both written and oral.
• Ability to positively influence others with respect and compassion.

Join us and discover the support to do more meaningful workand enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.