Continuing Care Manager - Social Worker

Dartmouth Health; Lebanon (NH); On-site; USD 89,000 - 124,000; Full time

Job summary

Dartmouth Health's inpatient Palliative Care social worker role focuses on psychosocial assessments and interventions for patients and families navigating serious illness at the Jack Byrne Center and DHMC.

The role requires an MSW with 5 years of clinical experience, strong leadership, communication, and collaboration skills, and comfort with computer systems. Benefits include generous core plans and equal opportunity employment.

Qualifications

• MSW required with 5 years of clinical social work experience.
• Strong analytical, problem-solving and communication skills.
• Collaborative, systems-based approach to care planning.
• Comfort with computer systems and data collection preferred.

Responsibilities

• Coordinate interdisciplinary care across the care continuum for defined populations.
• Conduct psychosocial assessments and develop comprehensive treatment plans.
• Advocate for patient needs and remove barriers to access to care.
• Monitor transitions across settings and share plans with patients/families.
• Identify gaps and work with networks to expand access to psychosocial services.
• Assist in developing disease management strategies and measure outcomes.
• Support interdisciplinary care delivery and resource utilization.
• Collect and evaluate outcomes data such as patient satisfaction and functional status.

Skills

Critical thinking

Leadership

Communication

Self-starter

Negotiation

Conflict resolution

Computer literacy

Team collaboration

Education

MSW (Master’s in Social Work)

Job description

Overview

The inpatient Palliative Care social worker facilitates psychosocial assessments and clinical interventions with patients and families navigating serious illness and end-of-life at the Jack Byrne Center and Dartmouth-Hitchcock Medical Center.

Responsibilities

1. Manages and coordinates interdisciplinary care of defined populations through the care continuum from wellness through end of life from a psychological, social and environmental perspective.
2. Identifies high risk patients requiring on-going coordination of care; performs a comprehensive patient/family assessment, develops a comprehensive treatment plan that will span the continuum of psychosocial issues, implements a plan of care to provide continuing support and coordination for patient/family with multiple complex system needs, manages benefits and negotiates continuing care services for enrollees in various health insurance plans, etc.
3. Utilizes innovative strategies to advocate for patient needs and negotiates complex systems to remove barriers and limitations in accessing health care in regards to psychological, social and environmental areas.
4. Monitors the patient’s transition across and within care settings (e.g., home, clinic, skilled nursing facility, rehabilitation, hospital, etc.).
5. Shares assessment and psychological, social and environmental care plan data with patient/family consent as the patient moves through different care settings.
6. Identifies gaps in the care continuum and work with the community and provider networks to expand access to needed psychological, social and environmental services.
7. Participates in the development of disease management strategies and identifies the appropriate measures for the evaluation of outcomes.
8. Participates in the development, maintenance, and coordination of an interdisciplinary care delivery system specific to individual patient needs and promotes effective resource utilization.
9. Collects and evaluates data/outcomes, including, but not limited to, patient satisfaction, health and functional status, and resource utilization.
10. Performs other duties as required or assigned.

Qualifications

• Master’s Degree in Social Work (MSW) with 5 years of clinical experience required.
• Critical thinking skills, strong leadership and communication abilities, the ability to be a self-starter, negotiate, and handle conflict resolution desired.
• Understanding of and comfort using computers desired.
• Collaborative team player, use of systems approach in planning, problem solving and decision making, creativity, innovation, risk taking, autonomy, flexibility, receptiveness to change and a commitment to professional growth desired.

Required Licensure/Certifications

- None

• Area of Interest: Allied Health
• Pay Range: $88,920.00/Yr. - $124,280.00/Yr. (Based on 40 hours per week, otherwise pro rata)
• FTE/Hours per pay period: 1.00 - 1.00 - 40 hrs/week
• Shift: Day
• Job ID: 41118

Dartmouth Health offers a total compensation package that includes a comprehensive selection of benefits. Our Core Benefits include medical, dental, vision and life insurance, short and long term disability, paid time off, and retirement plans. Click here for information on these benefits and more: Benefits | DHMC and Clinics Careers

Dartmouth Health is an Equal Opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy-related conditions), sexual orientation, gender identity or expression, national origin, ancestry, age, disability, genetic information, marital status, veteran or military status, or any other status protected by applicable federal, state, or local law.

Dartmouth Health provides reasonable accommodations to qualified individuals with disabilities and to applicants and employees with sincerely held religious beliefs in accordance with applicable law. Applicants who require an accommodation during the application or interview process may contact [e-mail] for assistance.