Social Worker (LSW) - Lorain
- Maintain a caseload of patients according to department policies.
- Identify, enroll and manage patients in program for Complex Case Management.
- Develop and implement care plans to maximize wellbeing with periodic review and update according to department protocols.
- Collaborate with ACM, PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.
- Perform situational and family assessment of social determinants of care and develop goals as part of the comprehensive care plan.
- Perform patient outreach according to established protocols and document in electronic medical record.
- Identify, execute, and track needed referrals to care and community resources.
- Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, and right time.
- Assist patient in advanced care planning to complete Advanced Directives.
- Document all communications with patient and/or care team in electronic medical record.
- Perform coordination of services for disabled status and/or facilitate placement in post-acute facility for rehabilitation or long term care.
- Act as patient advocate to address primary physical and socioeconomic needs and link patient to appropriate community resources and services.
- Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
- Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
- Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
- Tuition assistance, professional development and continuing education support
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