Social Work Care Manager -CPW

SKILLSKnowledge of health care conditions and needs of children and pregnant women.Ability to learn and apply case management and patient education skills.Strong interpersonal skills with the ability to build effective relationships across medical teams and with patients.Proficiency in problem identification and care plan development.Professional interaction skills with medical providers and other healthcare professionals.Skillfully conduct health assessments and screenings.Ability to learn and apply evidence-based behavioral strategies.Strong written and oral communication skills.PRIMARY DUTIESCoordinate and manage care for high-risk children and/or pregnant women to improve outcomes.Assess and respond to psychosocial, financial, functional, cognitive and medical needs.Identify and address gaps in patient care through proactive outreach and follow-up services.Identify and utilize patient’s systems of support and facilitators for reaching health goals.Monitor and respond appropriately to changes in patients’ condition, resources, or services.Serve as a liaison between primary care, specialty, and behavioral health services for coordinated patient treatment plans.Conduct comprehensive psychosocial needs assessments.Develop individualized care plans focusing on short and long-term medical and behavioral health treatment goals.Assist patients in navigating the healthcare system.Apply knowledge of community resources to address care gaps or improve quality of life conditions.OTHER DUTIESAs assigned by supervisor.Social Work Care ManagerChildren & Pregnant WomenREPORTS TO: Director of Care Management and Social Work Care Management Team LeadEDUCATION & EXPERIENCELMSWPreferred:Experience in social services, counseling, or case managementExperience providing social services in healthcare settingsTERM: Funding is secured through October 31, 2027. This revenue-generating role is expected to evolve into a self-sustaining, ongoing position, and every effort will be made to continue the role beyond the initial term.PHYSICAL AND MENTAL REQUIREMENTSPossess a valid Texas driver’s license and appropriate liability insuranceAccess to personal transportationVisual and auditory accuracyShift length variesIndoor settingContinuous use of computerLong periods of sittingFrequent use of telephone and/or smart devicesContinuous repetitive grasping and manipulation of both handsContinuous conversational communicationOccasional reaching, walking, squatting, bending, kneeling, twisting and climbingOccasionally carrying, lifting, pushing and pulling of up to 25 lbs.Occasionally working in confined, noisy, dusty areasUnderstand/carry out simple/detailed, oral/written instructionsMemorize and retain instructionsRead and interpret detailed specificationsMental competencyTobacco non-userPhysical accommodations will be implemented where necessary and feasible #J-18808-Ljbffr Waco Family Medicine