Palliative Care Social Work Case Manager

Job Description

A bit about this role

This specific role provides Social Work support to our Palliative Care Program.

Devoted’s virtual Palliative Care program serves members with complex needs and life-limiting illness who otherwise would not have access to specialized palliative care. We pride ourselves on providing highly compassionate, patient-centered goals of care counseling and symptom management for members projected to be in the final year of life. We meet patients where they are and support them in defining quality of life, achieving meaningful goals, and transitioning to hospice care.

As a Palliative Care Social Work Case Manager, you will serve our patients as an advocate, coach, and connector - working closely with patients, caregivers and other members of the team to identify and eliminate socioeconomic and psychosocial barriers and provide supportive counseling. This role will require you to develop individualized care plans that align community, clinical, and patients’ personal resources.You will provide coaching on improving coping skills, self-management, and caregiver assistance, re-enforce disease-specific education and facilitate goals of care and advanced care planning discussions, including hospice care transitions when appropriate.

Responsibilities will include:

• Telephonic and video visits with patients and caregivers

• Establish trust and build strong relationships with our patients

• Interdisciplinary collaboration with teammates (including clinicians, nurses, and care coordinators) to ensure cohesive, patient-centered care for high-needs patients

• Conduct Social Work interventions to maximize the effectiveness of the program

  • Conduct psychosocial assessments and create personalized care plans tailored to members’ needs

  • Provide emotional and caregiver support

  • Assist in navigating complex family/support issues

  • Complete goals of care conversations and advanced care planning

  • Conduct long term care planning and placements

  • Place/follow through on behavioral health referrals

  • Investigate concerns for patient abuse or neglect

• Know how to balance multiple competing priorities from complex patients

• Work with family members/caregivers to help them in understanding the member’s needs and how they can be supportive

• Manage or lead conversations with patients, caregivers, and family regarding goals of care, and social drivers of advanced care planning

• Facilitate and participate in family meetings and joint visits

• Participate in team huddles, panel reviews, interdisciplinary team rounds, and program/role growth and development

• Build relationships and coordinate with key local market and internal stakeholders

• Document all clinical interactions in the electronic health record

Attributes to success

• Ability to walk alongside those with terminal illness and to gentle the sacred transition from life to death

• You meet patients and families where they are, hold them with compassion, and are able to release yourself from the outcome

• You love helping others improve their health and navigate a complex healthcare system with compassion, empathy, and warmth

• You’re a caring problem solver who can break down barriers

• You connect with people quickly

• You follow up relentlessly

• A deep caring to make a change in the healthcare experience: you love to serve and make a difference

• The ability to adjust your tone and approach to different people

• You can articulate and break down complex information

• Being present, reliable and timely - for our members, for your team

• The ability to work in a startup environment: which means moving quickly and being transparent in your work, what’s going well, what’s not

• You enjoy a fast-paced, high-energy, organization; Agility and collaboration are key as we will change and improve quickly

• You are comfortable engaging and learning new technologies including electronic health records, operating systems and programs (Google Office, Slack). You thrive on knowing your work can help make these technologies better for you and your patients.

• You learn from every experience and are not afraid to fail - that's how you're wired

• Finally and most importantly, you have a passion for making healthcare better for patients at end-of-life, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members

Desired skills and experience

Must Haves

• Master’s degree in social work and active license

• Minimum of 2 years expertise in palliative or hospice with proficiency in leading goals of care conversations, assisting with advanced care planning, and supporting people through grief, loss, and bereavement

• Certified hospice and palliative social work credential, or willingness to obtain within one year of employment

• Comfortable with technology and a fast-paced environment

• Self-starter with ability to succeed in a work-from-home environment

• Strong interpersonal and communication skills

• Comfortable working with patients over video and phone

Nice to Haves

• Bilingual in English and Creole, Spanish, or Vietnamese.

• Experience in health insurance (Medicare Advantage a plus)

• Experience in geriatrics

#LI-Remote

Salary Range: $70,000 - $80,000 per year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.