COMMUNITY BASED SOCIAL WORK CARE COORDINATOR
Job Number: 00119935
Job Posting: Mar 22, 2017, 4:03:33 PM
Closing Date: Apr 6, 2017, 12:59:00 AM Full-time
Collective Bargaining Unit: SEIU Local 73 Posting Salary: $30.964 HOURLY
Organization: Health and Hospital Systems
The Community Based Social Work Care Coordinator (CBSWCC) supports the provision of care coordination in a manner that recognizes the Enrollee and the medical home care teams as essential partners in the Enrollee's care. These services are offered at the patient's home, physician office, and/or other health care facilities. If it is determined the Enrollees care is medically complex the CBSWCC collaborates with a nurse in the provision care coordination. Completes assessments of unmet health care needs and/or the presence of social determinants that impact the provision of care. Collaborates with Enrollee and medical home care team to develop and implement a care plan that mitigates barriers and links patients to appropriate resources. The CBSWCC works across sites of care and with multiple disciplines to achieve the desired outcomes for the Enrollees. Supervises the activities of the assigned Community Health Worker (CHW) (multiple vacancies)
- Uses all available information sources to support care coordination activities-this may include portals, electronic medical records, claims data, plan information, utilization management information, and Milliman Care Guidelines (MCG).
- Completes screenings, assessments and care plan in accordance with contractual requirements and Care Coordination policy and procedure.
- Integrates information from claims review, notes, screenings, assessments and Medical Home teams in care plan.
- Tracks patient progress regarding goal achievement on the care plan.
- Updates documents based on Enrollee progress, changes in priorities, changes in health status or new information.
- Supports care coordination referrals from multiple sources including Enrollee request, plan referrals, medical home referrals, grievances, data reports or changes in risk score.
- Provides relevant education, counseling and support to assist member with the achievement of goals.
- Collaborates with Nurse Care Coordinators on patients with multiple co-morbidities, frequent hospitalizations or inappropriate Emergency Department (ED) visits.
- Interfaces with Medical Home team and Enrollee at prescribed or agreed upon intervals.
- Participates in Interdisciplinary Care Teams, presents own patients, and provides guidance on others not directly managed.
- Conducts face to face visits on members with high or moderate risk stratifications on a quarterly basis.
- Conducts monthly outreach for high risk patients who are stable, more often for patients undergoing a transition or a change in treatment. Updates medical home team on status.
- Completes all required trainings, workshops, etc. within the required timeframe.
- Collaborates with medical home assignments to identify resources and process for effective communication.
- Conducts outreach to Case Management Department at hospital when Enrollees are admitted.
- Meets established case deadlines.
- Travels to the home of the Enrollees or their sites of care.
- Performs other duties as assigned.
- Licensed Clinical Social Worker in the Status of Illinois (must provide proof at time of interview)
- Three (3) years of work experience as a Licensed Clinical Social Worker(is required)
- Prior care coordination work experience in a social service agency, physician group, hospital or Emergency Department setting(is required)
- Valid Illinois Driver's license and mandatory vehicle insurance as required in the State of Illinois (In accordance with the Code of Ordinances of Cook County, Illinois codified through Ordinance No. 16-0692, enacted February 10, 2016 (Supp. No. 32) Sec. 2-673) (must provide proof at time of interview)
- Bilingual English/Spanish
Knowledge, Skills, Abilities and Other Characteristics
- Knowledge of Microsoft Office products
- Effectively communicates care coordination benefits to Enrollees, Medical Home Teams and hospital based staff
- Collaborates effectively with team members
- Ability to effectively prioritizes tasks
- Ability to work independently
- Ability to probe to get to underlying behaviors or Enrollee assumptions that are driving care coordination results
- Ability to communicate non-judgmental attitude
- Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan
- Deferred Compensation Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
- Meet the minimum qualifications for the position.
- Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, Are you a Military Veteran?
- Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
COOK COUNTY HEALTH AND HOSPITAL SYSTEMS IS AN EQUAL OPPORTUNITY EMPLOYER