Care Coordinator, LCSW

4 weeks ago

Minneapolis, United States Herself Health Full time

Care Coordinator, LCSW - Job Description Employment Type: Full Time, Exempt Level: Associate Location: Minneapolis, MinnesotaCompensation: Starting $55,000, dependent on experienceWho we are: At Herself Health, we're on a mission to help women get more life out of life, together. We are building a new model of primary care for women 65+ to solve long-standing problems: rushed appointments, long wait times, and care that's generalized rather than specialized towards women's needs later in life such as post-menopausal care, bone density, weight management, and mental, social and emotional well-being. Our patient-centric Primary Care clinics are dispersed across Minneapolis/St. Paul, MN. We are thrilled to serve the Twin Cities metro in our clinics located in Highland Park (St. Paul), Crystal, and South Minneapolis with new clinics launching soon in both Rosedale and Eagan. Our team of 100+ colleagues is on a mission to innovate the primary care landscape for women 65+. We're seeking like-minded individuals who share in this passion to join us About you: As we grow our early team, we are seeking strategic thought leaders who have a passion for building and innovating. We foster a culture of collaboration, excellence and the willingness to roll up our sleeves and learn as we grow. We have a customer first mindset, and we are looking for team members who share that. Our ideal candidates have strategic prowess and the ability to use data to build best practices and implement great ideas in collaboration with our team and our community. About the Care Coordinator Role: Reporting to the Company's Director of Utilization Management, the Care Coordinator role will be a key part in creating a continued care plan for our patients. Partnering with Providers, the Care Coordinator will help support chronic condition management and address medication adherence barriers for the patients while documenting patient visits and calls in the Company's electronic medical record system, or EMR. This role is expected to be a high-touch and visible role for our new and existing patients. Key Responsibilities: Engages with patients and their families to provide telephonic support as a member of the interdisciplinary teamPatient Advocacy and Support: Advocating for patients' needs and ensuring they receive appropriate and timely care. This includes helping patients navigate the healthcare system and accessing necessary resources.Care Coordination: Collaborating with healthcare providers, patients, and families to coordinate care plans that address medical, social, and emotional needs.Assessment and Evaluation: Conducting comprehensive assessments to identify patients' social, emotional, and environmental needs. This includes evaluating the impact of social determinants of health on patients' well-being.Resource Connection: Connecting patients with community resources such as housing assistance, financial support, food programs, and mental health services.Counseling and Psychosocial Support: Providing counseling and support to patients and their families to help them cope with illness, treatment, and life changes. This can include crisis intervention, grief counseling, and stress management.Health Education and Promotion: Educating patients about their health conditions, treatment options, and healthy lifestyle choices. This can involve group education sessions or one-on-one counseling.Cultural Competence: Ensuring that care is culturally sensitive and appropriate. Social workers must understand and respect the diverse backgrounds and experiences of their patients.Outcome Monitoring and Reporting: Monitoring patient outcomes to ensure that care plans are effective and making adjustments as needed. This includes documenting and reporting on patient progress and outcomes.Policy Advocacy: Advocating for policies that improve access to care and address social determinants of health. This can involve working with community organizations, healthcare providers, and policymakers.Ethical Practice: Adhering to ethical standards and principles in all interactions and interventions, ensuring confidentiality, informed consent, and respect for patient autonomy. Works closely with patients to reinforce the Primary Care Provider's plan of care for the patientWorks closely with patients to support patients in achieving their health goalsProvides support to patients related to self-management of chronic conditionsAddresses barriers to medication adherence with patientProvides support and addresses needs related to Social Determinants of Health (SDOH)Reinforces importance of regular follow-up visits with the PCPCoordinates care with other providers involved in the patient's care Identifies relevant Herself Health and community resources and facilitates program, network, and community referralsDocuments patient encounters in the electronic medical record system Qualifications and Skills: 2+ years of experience supporting patients in a chronic condition management programExperience engaging with patients telephonically LCSW Certification requires, or similar certificationKnowledge of available community resources and programs Excellent verbal and written communication skillsProficient in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variableRequires reliable internet and a home office set up conducive to discussions of sensitive health information Preferred Qualifications and Skills: CCM - Certified Case Manager Prior experience in a value-based care organizationPrior experience in a start-up environment We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discriminate on the basis of race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws. All employees of Herself Health are expected to fully understand abide by the practice's compliance policies and procedures. Employees are provided training upon hire and annually and regularly notified of changes as needed. It is an expectation that all employees will report any suspected violations of any federal or state laws to their direct supervisor, Human Resources, or the Compliance Officer.

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