HC8-KEN CAPS CASE MANAGER - SW

At Liberty Hospice, we understand the unique needs of our patients and families facing terminal illness. That is why Liberty Hospice provides our hospice patients with state-of-the-art care and pain management services, delivered by our specially trained staff with emphasis on strength, dignity and compassion.

We are currently seeking an experienced:

CAP CASE MANAGER – SOCIAL WORK

Full Time

(Duplin & surrounging areas)

JOB SUMMARY:

• Provides social work case management services to an assigned CAP client caseload and medical social work services to home health patients as assigned.
• Completes initial client and family social work assessments within one week of the initial client encounter.
• Participates in development of the client Plan of Care and identifies equipment, supplies, home care services, and other resources needed for inclusion in the plan.
• Performs home visits as indicated and at least as frequently as required by applicable policies and regulations.
• Develops and maintains case management plans with the client and appropriate personnel, addressing current and potential problems, the medical care plan, client goals, and available financial resources.
• Communicates case management plans, anticipated Medicaid spend-downs, and other client-related activities verbally and in writing to appropriate personnel and agencies.
• Performs follow-up assessments at least monthly, or more frequently when appropriate, and maintains contact with clients, community case managers, and service providers to monitor outcomes and continuity of care.
• Updates and revises case management plans with the client, case management team, physician, and other providers as indicated.
• Documents all patient-related activities within eight hours of the encounter.
• Advocates for clients and supports the identification and development of community resources; maintains a directory of available and needed services by geographic area.
• Consults with agency clinical staff, case management team members, and service providers to address client health, psychosocial, and financial needs.
• Maintains liaison with the Ryan White HIV consortium and provides benefits advocacy services when requested.
• Participates in community and professional education and networking programs related to CAP, case management, and social work services as requested.
• Meets with the Clinical Case Manager, supervisor, and Home Care Lead Nurse as appropriate, and re-evaluates work priorities at least monthly.
• Maintains productivity and an appropriate client caseload as negotiated with the supervisor; keeps the supervisor informed of developments with potential departmental impact.
• Assists with development and revision of case management policies and procedures and participates in multidisciplinary quality improvement activities.
• Attends at least 50% of IFD clinical conferences and at least one continuing education program annually related to social work or case management in HIV/AIDS patients.
• Contributes to service excellence and continuous quality improvement; works effectively as a team member and supports team recommendations.
• Maintains client and patient confidentiality, follows safe work procedures, adheres to work schedules and professional conduct standards, and performs other duties as assigned.

JOB REQUIREMENTS:

• Strong interpersonal, teaching, counseling, and collaboration skills.
• Ability to communicate effectively, both verbally and in writing
• Requires employee to have his/her own, reliable transportation.
• Ability to collaborate with clients, families, clinical teams, physicians, agencies, and community service providers.
• Demonstrated skill in assessment, problem identification, community resource development, and patient and family counseling.
• Requires knowledge of computer skills and the ability to learn Microsoft Word, Excel and use the EHR as well as the state's documentation system.
• Requires ability to work autonomously with skills in organization, timeliness and the ability to provide effective care for CAP patients and the family unit.
• Requires ability to engage a working knowledge of psychosocial principles and family dynamic development.
• Requires knowledge that allows for identification and reassessment of social, emotional, financial and environmental factors, which may affect care and desired outcomes.
• Compassion for chronically ill patients and sensitivity to their psychosocial and existential concerns.

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