Complex Care Manager: Discharge & Care Coordination

Bellin Health; Green Bay (WI); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

401(k) with matching

Paid time off

Tuition reimbursement

Wellness programs

Job summary

Emplify Health by Bellin in Green Bay, WI seeks a Social Worker to address barriers, develop and monitor individualized care plans with patients and families, and coordinate care across pre-, intra-, and post- hospital settings.

The role requires a Bachelor’s degree in social work, Wisconsin license, and 3+ years in a medical setting; Master’s degree preferred. 40 hours/week, 1.0 FTE, day shifts; no weekends, calls, or holidays.

Qualifications

• Bachelor’s degree in social work required; Master’s degree preferred.
• Wisconsin Social Worker license required.
• 3+ years of social work experience in a medical setting required.

Responsibilities

• Evaluate and address barriers such as complex clinical needs, mental health history, cognitive issues, social support gaps, treatment resistance, and financial or systemic obstacles.
• Develop and monitor individualized care plans in collaboration with patients, families, and interdisciplinary teams; evaluate and modify as needed.
• Use creative, evidence-based approaches to problem-solving and care coordination.
• Apply critical thinking to resolve complex patient needs and balance priorities.
• Coordinate the treatment planning process for patients in pre-, intra-, and post- care settings, as feasible.
• Lead discharge planning for patients with complex barriers preventing discharge from the hospital setting.
• Collaborate with treatment team to assure continuum of care.
• Develop relationships with community stakeholders and maintain knowledge of community resources.

Skills

Assessing patient care

Care coordination

Discharge planning

Community resources knowledge

Education

Bachelor’s degree in social work

Master’s degree in social work

Job description

Emplify Health by Bellin in Green Bay, WI seeks a Social Worker to address barriers, develop and monitor individualized care plans with patients and families, and coordinate care across pre-, intra-, and post- hospital settings.

The role requires a Bachelor’s degree in social work, Wisconsin license, and 3+ years in a medical setting; Master’s degree preferred. 40 hours/week, 1.0 FTE, day shifts; no weekends, calls, or holidays.