Job Summary
Supports, and is responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior.
Job Summary
Supports, and is responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior.
Example Of Essential Functions
- Delivery of care coordination within Frederick Health which may include hospital or ambulatory site assignment.
- Performs psychosocial assessment and planning to develop the plan of care to address identified needs.
- Identification of barriers to care including but not limited to socioeconomic status, unmet social needs, impaired coping, support network dysfunction.
- Promotes and values diversity to promote inclusive working relationships.
- Communication with interdisciplinary care team, patients, and families
- Promotes coordination with healthcare professionals.
- Monitors and evaluates care management plans.
- Provides education.
- Possesses working knowledge of regulatory components of assigned healthcare setting.
Required Knowledge, Skills, And Abilities
- Demonstrates effective interpersonal and communication skills, including superb customer service skills.
- Strong organizational and time management skills
- Excellent critical thinking skills, ability to work in a fact pace team environment, ability to multi-task, ability to adapt well to change and take on new challenges/projects, ability to effectively communicate and collaborate with physicians and staff.
- Ability to apply creative problem-solving skills to complex situations.
- Knowledge of clinical and psychosocial aspects of patient care
- Community resource knowledge
- Ability to work independently and interdependently.
- Personal creditability and the ability to serve as both a patient advocate as well as being committed to the health system goals.
- Upholds social work values, ethical principles, ethical standards
- Demonstrates skills in planning, organizing, and managing multiple functions and complex processes.
- Knowledge of basic computer software programs
Minimum Education, Training, And Experience Required
- Graduation from an accredited school of social work with a Bachelors or Master's degree in social work with a current Maryland license. Master's Degree preferred.
- Three to five years of care management and/or healthcare experience.
- Care Management certification preferred including but not limited to Accredited Case Manager (ACM) certification.
- Certified in Cardiopulmonary Resuscitation (CPR) - not applicable for employees working in an approved, full-time remote position.
- Completes Maryland Board of Social Work continuing education (CEU) requirements to ensure licensure is in good standing.
Patient Contact
- _X_ Neonate (0 thru 30 days)
- _X_ Infant (31 thru 12 months)
- _X_ Child (13 months thru 12 years)
- _X_ Adolescent (13 years thru 17 years)
- _X_ Adult (18 years thru 65 years)
- _X_ Geriatric (66+ years)
Physical Demands
Light Work - Lifting up to 20 pounds on an infrequent basis (less than one lift every three minutes and/or carrying up to 10 pounds, or requiring walking or standing to a significant degree (about six [6] hours a day).
Ergonomic Risk Factors
Repetition: Repeating the same motion over and over again places stress on the muscles and tendons. The severity of risk depends on how often the action is repeated, the speed of the movement, the required force and muscles involved.
Awkward Posture: Posture is the position your body is in and its effect on the muscle groups that are involved in the physical activity. Awkward postures include repeated or prolonged reaching, twisting, bending, kneeling, squatting, working overhead with your hands or arms, or holding fixed positions.
Working Conditions
- Bloodborne Pathogens Exposure Risk: Category B - MAY have exposure to blood or body fluids.
Reporting Relationship
Reports to Department Manager
Integrated Care Management
- The Integrated Care Management- Care Manager Social Worker will work collaboratively with physicians, staff, and other healthcare professionals within ambulatory Frederick Health Medical Group practices and/or community practices that participate in the clinically integrated network (CIN)- Frederick Integrated Healthcare Network (FIHN). Care coordination will focus on requirements of various value-based care contracts and population health focus areas. Transitions of care, risk stratification data, and provider/care team referrals will initiate care management within this population. The Care Manager Social Worker will interpret data to evaluate and implement care management strategies and interventions related to attributed beneficiaries and patient populations. Optimizes patient wellness through the promotion of self-management strategies. Telephonic, medical office, and home visits will be conducted.
Transitional and Chronic Care Management Program
- The Transitional and Chronic Care Management (TCCM) Social Worker will work collaboratively with the TCCM clinicians, community programs and Frederick Health Hospital case managers. Social worker will focus