Home-Based Community Care Team Manager

Andwell Health Partners; Lewiston (ME); On-site; USD 28,000 - 52,000; Full time

Benefits offered by this job

Health Insurance

Education Reimbursement

Paid Time Off

Internal Promotions

Job summary

Andwell Health Partners in Lewiston, ME is seeking a Care Manager Social Worker to coordinate patient-centered care for a defined population in collaboration with primary care practices. This role emphasizes housing support for HOME enrolled patients to reduce unnecessary hospital visits.

You will engage patients to improve overall health and well-being, work with MaineCare and providers to close care gaps, and support complex emotional-social needs in community and home settings.

Qualifications

• Bachelor’s degree in Social Work, Sociology, Public Health, or Nursing required.
• Combined five years of education and experience in providing direct services in social, health, or behavior health fields.
• MHRT/C Certification acceptable.

Responsibilities

• Coordinate services with primary care practices to provide patient-centered care.
• Engage patients to reduce unnecessary health care services and improve health; housing support for HOME enrolled patients.
• Assess gaps in care coordination with practices and community supports.
• Collaborate with physician practices and community partners to address needs of the most complex patients.
• Work with patients with complex emotional-social issues and mental health concerns.
• Identify recipients who would most benefit from care management and obtain consent to participate.
• Make patient visits prior to hospital discharge, in the primary care practice, in the home or public settings.

Education

Bachelor’s degree in Social Work

MHRT/C Certification

Job description

Andwell Health Partners in Lewiston, ME is seeking a Care Manager Social Worker to coordinate patient-centered care for a defined population in collaboration with primary care practices. This role emphasizes housing support for HOME enrolled patients to reduce unnecessary hospital visits.

You will engage patients to improve overall health and well-being, work with MaineCare and providers to close care gaps, and support complex emotional-social needs in community and home settings.