• Jacksonville, North Carolina
  • Autofill and Review
30+ days ago

Job Description

Primary Functions:

  • ·         Responsible for patient outreach, assessment, disease management, and care coordination to patients with high rates of medical and behavioral health utilization and/or psychosocial vulnerability

    ·         Assess patients through telephonic and eventually face to face encounters

    ·         Builds a collaborative relationship with patients and their identified support system to encourage care participation and improve self-management of needs

    ·         Utilize motivational interviewing to identify barriers and facilitate care plan compliance

    ·         Effectively educate patients about healthcare delivery, plan benefits and a variety of topics related to health, and community resources

    ·         Coordinates timely and appropriate implementation of assessments, care plans, and interventions for the identified patient population

    ·         Provide medication reconciliation and support ongoing adherence

    ·         Provide transitional care management

    ·         Identify and helps to align patient care and community resources to prevent hospital readmissions and Emergency Department visits

    ·         Document all activity in the documentation systems relevant to the role

    ·         Collaborate with the care team to achieve high-quality, low-cost outcomes for patients.

    ·         Interface and maintain positive relationships with key providers in the local hospitals, community practices, and organizations to ensure proper patient engagement and follow up

    ·         Achieve established productivity targets

    ·         Maintain compliance with the organization policies and procedures

    ·         Demonstrate the ability to adapt, innovate and lead in a fast-paced environment, where change is common

    ·         Passionate about making a difference in individual’s lives

    ·         Other duties as assigned

Qualifications:

  • Requires a Master’s in Social Work
  • Must have a current full licensure as a LCSW by the NC Social work Certification and Licensure Board
  • Two years post master’s clinical experience is required
  • Medical Social Work experience strongly preferred
  • Knowledge of care management and quality principles are preferred
  • Requires the ability to maintain confidentiality
  • Must be able to interact with individuals of all cultures and level of authority

Additional skills required:

  • Excellent and effective written and oral communication skills.
  • Proficiency in Microsoft Office Outlook, Word, Excel, PowerPoint use and e‐mail communication.
  • Ability to communicate clearly and succinctly.
  • Dependable, manages time well; efficient and organized.
  • Must be able to interact with individuals of all cultures and levels of authority.
  • Requires the ability to maintain confidentiality.

Benefits:  

  • 401(k)  
  • Health, Dental and Vision insurance  
  • Employee assistance program  
  • AFLAC
  • Paid time off

Numbers & Facts

LocationJacksonville, North Carolina

Skills

  • Behavioral Healthunmatched
  • Clinical Medicineunmatched
  • Communication Skillsunmatched
  • Dental Insuranceunmatched
  • Disease Prevention and Controlunmatched
  • Emergency Careunmatched
  • Health Educationunmatched
  • Health Planunmatched
  • Hospitalunmatched
  • Licensed Clinical Social Worker (LCSW)unmatched
  • Maintain Complianceunmatched
  • Medicationsunmatched
  • Microsoft Excelunmatched
  • Microsoft Officeunmatched
  • Microsoft Outlookunmatched
  • Microsoft PowerPointunmatched
  • Microsoft Wordunmatched
  • Organizational Skillsunmatched
  • Patient Assessmentunmatched
  • Patient Careunmatched
  • Patient Educationunmatched
  • Patient Follow-upunmatched
  • Presentation/Verbal Skillsunmatched
  • Reconciliationunmatched
  • Social Workunmatched
  • Team Playerunmatched
  • Time Managementunmatched
  • Transitional Careunmatched
  • Vision Planunmatched
  • Writing Skillsunmatched

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