Job Information

St. Joseph Health / Covenant Health Social Worker Care Manager - Care Management in Fullerton, California

We are looking for a Social Worker Care Manager for the Care Management Department at St. Jude Medical Center.

Location: Fullerton, CA

Work Schedule: On Call/ Per Diem

Shift: 8-hour, Days

Job Summary:

Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination and addressing the psych social needs of the patient. The goal of the Care Manager, Social Worker is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The Care Manager Social Worker utilizes the following processes to meet the patient's individual healthcare needs: assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care.

Essential Functions:

  • Assessment: The Care Manager will collect in-depth information about a persons’ situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient’s needs. The Care Manager will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient’s well-being. This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations.

  • Planning: The Care Manager will identify specific objectives, goals and actions, as identified during the assessment process. Acting as a patient advocate the Care Manager will collaborate with the physician, the patient & family, and members of the healthcare team, to formulate a shared plan of care. Goals and time frames for goals, appropriate to the patient, will be set.

  • Implementation: Executes specific interventions that will lead to accomplishing the goals and timeframes of the shared plan of care. Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process. The Care Manage will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.

  • Coordination: Organizes, coordinates, provides, modifies or obtains appropriate authorizations, utilizing appropriate utilization review and evidence of coverage guidelines, to accomplish the patient’s goals. Initiates and communicates with the patient and family, physicians, healthcare members, and community and payor representatives. Facilitates continuity of care throughout all access points involving Health Plan, discharge planners, physicians and other appropriate staff.

  • Monitoring: Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and services provided. Manages a caseload of high risk, complex needs and/or catastrophic patients.

  • Evaluation: At appropriate and repeated intervals, assesses and reassesses the patients’ progress. If progress is static or regressive, determines the reason and encourages the appropriate interventions to obtain optimal outcomes. The Care Manager will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.

  • Communication: Communicates both verbally and electronically with the patient and the healthcare team. Appropriately documents the plan of care, outcomes, statistical reporting, logs, and files abiding to departmental, legal and regulatory requirements.

Skills:

  • Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum.

  • Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way.

  • Excellent interpersonal, verbal and written communication skills.

  • Ability to problem-solve.

  • Ability to access and evaluate community resources to meet patient’s needs.

  • Ability to handle multiple tasks at a time and remain organized.

  • Ability to work autonomously but demonstrates the ability to work collaboratively on a team.

  • Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities.

  • Excellent computer and IT system knowledge.

  • Possesses the knowledge and skills necessary to communicate with third party payers.

  • Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner.

  • Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system.

  • Proficiency in Milliman Care Guidelines (Mcg).

Minimum Position Requirements:

Education: Master's Degree in Social Work, Psychology, Counseling, or Master’s Degree with 5 years relevant social work experience.

Experience: 6 months Clinical experience in an HMO, medical group, affiliated model, hospital, or medical office/clinic setting.

Licenses/Certifications: Current American Heart Association BLS Health Care Provider.

Preferred Position Qualifications:

Experience:

  • 3 years experience in utilization management or case management.

  • Experience with Psychiatric chemical dependency treatment.

  • Managed care experience.

Licenses/Certifications:

  • Licensed Clinical Social Worker (LCSW).

  • Certification in Case Management (CCM, ACM).

Apply Today! Applicants that meet qualifications will receive a text with some additional questions from our Modern Hire system.

St. Jude Medical Center is a faith-based, non-profit, 384-bed, tertiary care facility, and is one of Southern California's most-respected and technologically-advanced hospitals. With nearly 700 of the area's finest physicians on staff, St. Jude offers nearly every medical specialty and sub-specialty. Whether for the birth of a baby, life-saving surgery or a routine mammogram, St. Jude continues to set the standard for medical care and offers the community the most comprehensive array of services and programs.

St. Jude Medical Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Jude Medical Center complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Positions specified as “on call/per diem” refers to employment consisting of shifts scheduled on as “as needed basis” to fill in for staff vacancies.

Company: St. Jude Medical Center

Category: Social Work

Req ID: R357147