Home Health Social Worker Care Manager

About the job Home Health Social Worker Care Manager Overview

Social Workers are needed
for a dynamic, fast-paced start-upwith an innovative
care management position
that is transforming the delivery of kidney care. You will be
driv
b
ing to patients' homes
who suffer from chronic kidney disease. We are looking for someone who works well with
ambiguity
, drive time,
and telehealth
components. Most
patients are suffering from
chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Requirements:

• Work
  Mondayto Friday 8:00 am to 5:00 pm and
  occasionally after 5:00 pm
• You must be mission-driving and willing to
  deal with underserved populations
• Master's Degree in Social Work
  , behavioral sciences, or another related field
• Currently licensed as an
  LCSW or LMSW
• 2+ years of experience
  working
  in care management
  and/
  or with chronic illness2+ years of experience
  working in medical settings such as
  home health, dialysis, or hospice
• Tele-health!Ability to
  take calls remotely on some nights and weekends
• Self-starter with the
  ability to work independently
  with minimal supervision
• Must
  show empathy
  and quickly
  build relationships with patients and CBOs
• Excellent
  verbal communication skills
  both in person and on the phone
• Must be fully vaccinated
• Must be willing to travel to the patient's home
• Competitive compensation,of$65,000
• Flexible paid leave(PTO),
  sick days, and vacation policy
• Full Benefits
  (Medical, Dental, & Vision)
• 401K Plan
• Laptop & Phone Allowance
  (if applicable details will be discussed)

Job Description s:

• Lots of driving!This position will cover a
  two-hour travel radius
  .
• Rare domestic travel
  may be required to
  headquarters in Nashville, TN
• Ability to occasionally visit patients or take calls remotely on
  some nights and weekends
• Work with
  Microsoft Office
  and
  mobile phone and web-based applications
• Perform in-home care management
  t visits to assess and impact their social and behavioral status
• Work closely with Care Team
  to ensure continual progress on all care management goals
• Assess social determinants
  of health needs and develop a plan for addressing them
• Perform behavioral, environmental, and social support
  assessments and surveys
• Deliver individual, family, and group education
  on living with chronic illness
• Engage
  family and social support groups
  in the education and care of patients
• Assess patients and
  refer them to behavioral health specialists
  for diagnosis and treatment
  Help patients
  to understand accept and follow medical and lifestyle recommendations
• Serve as the point of contact
  for patient questions regarding social and behavioral
• Facilitate conversations
  around and consideration of proactive care decisions, especially relating to
  transplantation, home modalities, and AV fistula placement
• Initiate patient relationships through
  enrollment and onboarding
  processes
• Document patient updates
  and progress in the
  EMR
• Identify, vet, and build relationships
  with local Community-Based Organizations
• Introduce patients to appropriate resources and
  act as the patient advocate
• Serve as subject matter expert
  on social determinants for other members of the Care Team

Interview Process:

• Brief screening call with a talent advisor
• Phone Interview with HR
• Video Zoom interview the operations manager and leadership