Clinical Social Worker

3 weeks ago

Okemos MI, United States HarmonyCares Full time

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice.
 
Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care.
 
Our Shared Vision – Every patient deserves access to quality healthcare.
 
Our Values – The way we care is our legacy. Empower and support each other.
 
Health, Dental, Vision, Disability & Life Insurance, and much more
~401K Retirement Plan (with company match)
~ Tuition, Professional License and Certification Reimbursement
~ Paid Time Off, Holidays and Volunteer Time
~ Paid Orientation and Training
~ Day Time Hours (no holidays/weekends)
~ Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today

The Clinical Social Worker works collaboratively with the Care Team to provide care management services and helps address an individual’s ability to maintain independence in the home, chronic care management, end of life decisions, cognitive/functional status, frequency acute care utilization, and a patient/caregiver support system. Manage a caseload of high risk socially complex patients
Investigate psychological and social determinant barriers and design appropriate interventions to assist in closing gaps in care and needs
Provide outreach to community based services to support the patient’s ability to age at home
Develop and implement shared goals of care with the patient and family
Provide feedback to the home based primary care physician(HBPCP) to ensure he/she is aware of any early patient changes
Participate in Multidisciplinary Care Planning Rounds
Work with Community based agencies to develop relationships and provide appropriate resources to assist in maintaining patient independence
Other duties/projects as assigned
Participates in quality improvement activities aimed to improve patient-population outcomes and associated processes.
Master’s Degree in Social Work
~ Current unrestricted Social Work License or Limited License with preceptor or must be a licensed and boarded CSW or become licensed and boarded within 1-year
~ 3 years of experience in Care Management in community based setting or equivalent
~ Above average computer skills
~ Ability to be self-directed and able to communicate effectively with professional staff across many disciplines and programs
~ Ability to share expertise with others and demonstrates an understanding of the need to foster performance improvement while achieving patient satisfaction and efficiency
~ Experience with the homebound population, managed care, ACO, medical home or integrated case management environment is preferred

Experience working with the chronic, complex and/or behavioral health population

HarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.

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