Care Management Social Worker - Internal Medicine
Transitional Care Management/P4P
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This position may be filled as a Level I, II, or III, depending on specific education, experience, and license requirements.
SHIFT: Days
A Care Management Social Worker will provide essential support and guidance to patients and their families as they navigate overall wellness in the OU healthcare system. This position provides comprehensive care coordination and support services to individuals and families facing complex social and health-related challenges. This position works collaboratively with clients, their families, healthcare professionals, and community resources to address their unique needs and improve their overall well-being.
Essential Responsibilities
Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.
Assess assigned patients’ unique conditions by combining data from medical diagnoses, chart reviews, personal interviews, and care teams.
Performs psychosocial assessments and relate findings to necessary clinical staff
Provides or supervises plan of care interventions to include resource and referral help, crisis intervention, prevention, education, patient advocacy, bereavement, therapy (LMSW under supervision) and support as appropriate. Partners with the healthcare team and involves the patient and family in the development and implementation of plans.
Provides patients and family education regarding diseases, treatments, social or financial situations, emotional stress and/or other problems
Monitors care to evaluate progress towards goals and institutes appropriate interventions as needed
Conduct high risk screening, provides crisis counseling (LMSW under supervision), and provides education and resources to patients and families regarding abuse or neglect, physical abuse, and documents these sessions.
Acts as a liaison between patients/families and the clinical staff and other agencies
Advocate for patient concerns and escalate ethical dilemmas through the appropriate channels.
Maintains an open, approachable manner treating others fairly and respectfully preserving self-confidence and dignity as well as show regard for their opinion
Completes applicable reports bases on mandated reporting requirements.
LMSW or LCSW with 1 year experience can precepts newly hired SW Level I or BSW and MSW students.
General Responsibilities
Minimum Qualifications (Level 1):
Education Requirements: Master of Social Work from an accredited institution required
Experience Requirements: 0-3 years of work experience, health care experience preferred.
License/Certification/Registration Requirements: Current Licensed Master Social Worker (LMSW) or under supervision for Licensed Clinical Social Work (LCSW) or LCSW from the Oklahoma State Board of Licensed Social Workers. Current Basic Life Support certification from the American Heart Association required.
Minimum Qualifications (Level 2):
Education Requirements : Master of Social Work from an accredited institution required.
Experience Requirements: At least 3 years of social work experience.
License/Certification/Registration Requirements: Current LCSW from the Oklahoma State Board of Licensed Social Workers. Current Basic Life Support certification from the American Heart Association required.
Minimum Qualifications (Level 3):
Education Requirements : Master of Social Work from an accredited institution required.
Experience Requirements: At least 5 years of social work experience.
License/Certification/Registration Requirements: Current LCSW from the Oklahoma State Board of Licensed Social Workers. Current Basic Life Support certification from the American Heart Association required.
Knowledge/Skills/Abilities Required
Analytical skills sufficiently strong to interpret situations and determine the appropriate course of action.
Ability to explain information in a way that patients, families, and staff can understand.
Good interpersonal skills.
Basic knowledge of healthcare regulations, including CMS guideline.
Serve as liaison between patients, families, and healthcare providers.
Strong communication, interpersonal, and leadership skills.
Detailed- oriented with excellent organizational skills.
Commitment to learn and foster a culture of continuous learning, quality improvement, and patient-centered care.
Knowledge of assessment, critical thinking, and problem-solving skills.
Ability to assess, diagnose and treat mental health conditions through providing counseling services (LMSW under supervision or LCSW).
Completion of clinical supervision requirements.
Strong ethical standards and professional integrity; knowledge of Code of Ethics.
Knowledge of the principles and practices of casework.
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