Social Worker II - CMHRP

Primary Purpose of the Position To provide the delivery of pregnancy care management services that improve birth outcomes in the North Carolina Medicaid population and thereby reduce costs. The pregnancy care managers, working with the DHB network, provide a variety of services in the form of population management and direct pregnancy care management. Job Responsibilities Utilize targeted data and referrals to identify patients who may benefit from pregnancy care management. Engage pregnant and postpartum women with priority risks and document pregnancy assessments, conditions/needs, interventions, goals, and other care activities in Virtual Health. Recruit and initiate referrals from multiple sources, including Pregnancy Medical Home Practices, hospitals, community agencies, and self-referral. Maintain ongoing contact with local physicians and community agencies to promote referrals for high‑risk pregnancy care management. Serve as the Care Manager for Medicaid eligible pregnant and postpartum women in Nash County following State DHB, PHP and DHHS guidelines, performing outreach, population identification, risk stratification, and interventions per the Care Management for High Risk Pregnancy Standardized Plan. Provide coordination and integration with health care providers, including Medical Home and local Prepaid Health Plan network. Assist clients and families in accessing appropriate community services and referrals, including WIC and educational resources. Counsel on the importance of early and continuous prenatal care and adherence to medical recommendations. Maintain rapport with agency staff and external service providers, serving as liaison with physicians, Home Health, hospitals, Department of Social Services, and Regional High Risk OB clinic. Continuously update knowledge and skills in Maternal, Child Health and Public Health. Participate in disaster services, community activities, monthly staff meetings, and relevant committees on infant mortality. Represent the Agency in court only when subpoenaed to testify. Perform additional duties as assigned by the Social Work Supervisor or Health Director. Major Activities 90% Case Management – assessing patients, developing care plans, counseling, referral, follow‑up, monitoring, and advocacy. 10% Resource Development/Community Liaison – serving as a liaison with other service providers, attending workshops, and promoting CMHRP through speaking engagements. Eligibility & Qualifications Bachelor of Social Work (BSW), BA in SW, or BS in SW from a Council on Social Work Education (CSWE) accredited program; or Master of Social Work (MSW), MA in SW, or MS in SW from a CSWE accredited program. Three to five years of case‑management experience working with low‑income pregnant individuals or children ages 0 to 5 years. Certification as a Case Manager (CCM) preferred. Valid North Carolina Driver's License. Knowledge of social work principles, psychosocial assessment, community resources, laws, and health terminology relevant to the program. Established counseling skills and ability to maintain confidentiality and professional relationships. Working Conditions Work may occur in patient homes, agency offices, and exam rooms. Employees may be required to make home visits alone or in pairs when safety concerns arise. Travel to local hospitals and client homes is required. Legal Notice Equal opportunity employer; protected categories as defined by federal law. #J-18808-Ljbffr