Care Manager - Social Work (Health & Behavioral)

Waco Family Medicine; Waco (TX); In loco; USD 55.000 - 85.000; Tempo pieno

Descrizione del lavoro

Waco Family Medicine in Waco, TX is seeking an experienced licensed social worker to coordinate care for high-risk patients within a collaborative care team. The role focuses on case management, disease management, patient education, and linking patients to community resources.

Responsibilities include developing individualized care plans, leading care team meetings, and guiding patients through the health system. A LMSW and healthcare social services experience are preferred.

Competenze

• Licensed LMSW with social services credential.
• Experience in social services, counseling, case management, or vocational rehabilitation is preferred.
• Healthcare settings experience is preferred.

Mansioni

• Coordinate and manage care for high-risk patients to improve outcomes and minimize hospital utilization.
• Develop and maintain a tracking system for seamless care coordination across services and referrals.
• Identify and address gaps in patient care through proactive outreach and follow-up services.
• Implement standing delegated orders and management protocols.
• Participate in or lead regular Care Team meetings.
• Serve as liaison between primary care, specialty, and behavioral health services for coordinated treatment plans.
• Offer coaching to patients on self-management for chronic conditions.
• Conduct psychosocial needs assessments and develop individualized care plans.

Conoscenze

Case management

Disease management

Patient education

Interpersonal skills

Care plan development

Communication skills

Chronic condition knowledge

Motivational interviewing

Health assessments

Team collaboration

Formazione

LMSW

Descrizione del lavoro

Waco Family Medicine in Waco, TX is seeking an experienced licensed social worker to coordinate care for high-risk patients within a collaborative care team. The role focuses on case management, disease management, patient education, and linking patients to community resources.

Responsibilities include developing individualized care plans, leading care team meetings, and guiding patients through the health system. A LMSW and healthcare social services experience are preferred.