Job Description
Description
The general salary range for this job opening at PeaceHealth is $36.55 – $54.83. The actual hiring rate is dependent upon several factors, including but not limited to, the job/position responsibilities, location, terms of the applicable collective bargaining agreement, education, training, work experience, seniority, work performance, etc.
**Hiring Bonus for eligible candidates!**
**Relocation assistance available**
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Job Summary
Responsible for identifying and interacting with medically and psychosocially complex patients and families who are likely to benefit from care management and meet high risk criteria and for coordination of discharge planning services for these patients in collaboration with RN Care Management and other members of the care team.
Essential Functions
- Screen and identify patients who need care management per high-risk criteria.
- Assess, develop, implement and monitor a comprehensive discharge plan of care through an interdisciplinary team process in conjunction with the patient and family. Collaborate with the multi-disciplinary team to identify problems or needs that require special planning, intervention, teaching or follow-up.
- Identify key problems, strengths and resources to be addressed in the discharge plan of care. Coordinate and facilitate improved ability to comply with plan of treatment; counseling or support needed to cope with situation; improved ability to access appropriate level of care due to lack of financial resources or lack of available service.
- Actively support measures that promote effective use of resources.
- Identify, plan and arrange for appropriate services applying a knowledge of services available in the community, state, and federal health regulations and admission, discharge and appropriate level of care. Coordinate effective planning and arranging for needed services upon discharge.
- Intervene by arranging services, education and providing psychosocial support to prepare the patient and their family to manage their healthcare needs within the acute care setting and post discharge.
- Coordinate with the interdisciplinary team and community resources when appropriate, regarding the multiple details of transitional care management plan. Consult with physician as indicated.
- Works with patients identified and referred to them by RN Care Management and/or other members of the care team, as well as by patients/families.
- Conducts evaluation to include appropriate documentation and the effectiveness of the Care Management services. Collaborates with team members to identify cause and adjust plan if patient’s health status is not improving.
- May counsel patients and/or families to facilitate and/or participate in community care services, in coordination with the physician and treatment team. Works as an integral member of the treatment team in the coordination of treatment and transition of care planning. Assesses and addresses both mental health and chemical dependency conditions. May perform risk assessments for suicidality and homicidality.
- Performs other duties as assigned.
Qualifications
Education
- Bachelor's Degree: Social Work or related field with a minimum of four years’ work experience in a medical or healthcare setting, social service agency, or community organization focusing on health and/or welfare issues (Required). Critical Access Hospital ONLY or
- Master's Degree: Social Work or related field (Required) or
- Master's Degree: Counseling or related field (Required)
Experience
- Minimum of 2 years Employment in a healthcare setting or community agency dealing with health and/or welfare issues (Preferred) and
- Demonstrated knowledge of community health, welfare, and social agencies (Preferred) and
- Demonstrated knowledge of and ability to apply age specific principles of growth and development and life stages to meet each patient’s needs (Preferred) and
- Demonstrated proficiency in social work practice (Preferred)
Credentials
- Certified Case Manager (Preferred) and
- Preferred: Licensed Clinical Social Worker - Oregon (Oregon Requirement) or
- Required within 90 Days: Counselor Agency Affiliate (Washington Requirement: Applied for or received) or
- Required Upon Hire: Washington State Social/Counseling Work Credential (Washington Requirement: Other applicable Social Work, Therapist or Counselor licenses) or
- Preferred: Licensed Clinical Social Worker - Alaska (Alaska Requirement) or
- Preferred: Licensed Master Social Worker - Alaska (Alaska Requirement: or Licensed Baccalaureate Social Worker)
Skills
- Excellent verbal and written communication skills including sensitivity to other cultures and ethnicities. (Required)
- Excellent skills in conceptual thinking, listening, problem resolution and planning. (Required)
- Demonstrated leadership skills. (Required)
- Excellent organizational skills. (Required)
- Proficient computer skills including MS Office applications and electronic medical records. (Required)
- Knowledgeable about issues related to chronic illness, developmental disabilities, special needs, mental illness, grief and transition, substance abuse, domestic violence, child abuse and senior abuse. (Required)
- Good understanding and adherence to core social work values and ethics. (Required)
Department / Location Specific Notes
Oregon West Network – BHS Partial Hospitalization/Intensive Outpatient:
- CADC preferred
- Job requires experience leading therapeutic groups including CBT, DBT, art therapy, movement therapy, and treatment of co-occurring disorders Peace Harbor:
- Must qualify for Medicare provider number which allows for billing counseling services.
- LCSW with substance abuse experience / CADC preferred
- Role includes management of psychosocial / behavioral aspects of chronic and acute diseases; ability to provide brief focused interventions; must be able to function in busy primary care setting.
Working Conditions
Lifting
- Ability to move around area with occasional sitting.
- Bend/ twist/ reach/ push/ pull occasionally.
- Lift/Carry: Occasionally up to 5 lbs.
Environmental Conditions
- Exposure to biohazard, body fluids and airborne particles.
- Time spent on site in medical/hospital setting or in office environment.
Mental/Visual
- Vision and hearing required within normal limits (glasses, contacts, hearing aids permitted).
- Ability to communicate and exchange accurate information.
PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.
See how PeaceHealth is committed toInclusivity, Respect for Diversity and Cultural Humility.
For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.
PeaceHealth requires a completed Primary Vaccine Series (e.g., 2 dose monovalent Pfizer, Moderna or Novavax series or 1 dose J&J vaccine series) or be Up to Date (receiving the most recent Pfizer/Moderna bivalent vaccine/booster) for COVID-19 vaccination prior to their start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due to medical/religious reasons. For caregivers that will be working in Oregon there is a personal vaccine exemption form that may be requested.