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Care Manager - Social Worker

Company: Monogram Health
Location: Tucson
Posted on: September 23, 2022

Job Description:

About Monogram Kidney Care ClinicMonogram Health supports patients suffering from Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) by forming deep rooted relationships and preparing them both emotionally and physically for the challenges of managing kidney disease.Position: Care Manager Social WorkerAs a key member of a Care Team, the Care Manager - SW works with patients face-to-face, over the phone and through telehealth to identify and address social determinants of health, build up and engage a patients social support network, navigate behavioural challenges, and generally help patients through a very traumatic diagnosis and life-changing disease. Roles and Responsibilities

Initiate patient relationships through enrollment and onboarding processesPerform in-home care management visits to assess and impact social and behavioural statusAssess social determinants of health needs and develop a plan for addressing themAssess patients and refer to behavioural health specialists if diagnosis and treatment neededIntroduce patients to appropriate resources and act as the patient advocatePerform behavioural, environmental, and social support assessments and surveys as neededHelp patients to understand, accept and follow medical and lifestyle recommendationsDeliver individual, family and group education on living with chronic illnessEngage family and social support groups in the education and care of patients Serve as the point of contact for patient questions regarding social and behavioural Facilitate conversations around and consideration of proactive care decisions, especially relating to transplantation, home modalities and AV fistula placementReview and document patient updates and progress in care management platformIdentify, vet, and build relationships with local Community-Based OrganizationsWork closely with Care Team to ensure continual progress on all care management goalsServe as subject matter expert on social determinants for other members of the Care Team -Position Requirements
This position requires frequent car travel throughout the stateRare domestic travel may be required to Brentwood, TNMasters Degree in Social Work, behavioural sciences, or another related fieldCurrently licensed as a LCSW or LMSW in the State of Arizona2+ years previous experience working, as a LCSW/LMSW in care management and/or with chronic illness Ability to visit patients and/or take call on nights and weekendsFamiliarity with Microsoft Office and mobile phone and web-based applicationsBenefits
  • Opportunity to work in a dynamic, fast-paced, and innovative care management company that is transforming the delivery of kidney care
  • Comprehensive medical, dental, vision and life insurance
  • Flexible paid leave & vacation policy
  • 401(k) plan with matching contributions
  • Health Savings Account (HSA) and Flexible Spending Account (FSA) -Monogram Health Care Managers are in the perfect position to facilitate meaningful improvement in the lives of very ill patients. A significant number of patients with Chronic Kidney Disease and End Stage Renal Disease are economically disadvantaged and lacking the support needed to care for themselves properly, all while often struggling with multiple serious diseases and behavioural health challenges. Care Managers can remove the many economic and behavioural barriers to patients experiencing great health outcomes. -Monogram Health is dedicated to improving the well-being, quality of life and health outcomes for our patients by partnering with the nation's leading kidney specialists to provide transformative kidney care. - Monogram Health uses next generation artificial intelligence algorithms to predict necessary and timely care to promote the delay of kidney disease progression, seamless transitions to dialysis and/or pre-emptive kidney transplant. We then utilize in-home visits to build meaningful relationships between patients and their care team that drive positive behavior change and optimize our patients health outcomes. -At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences. -

Keywords: Monogram Health, Tucson , Care Manager - Social Worker, Executive , Tucson, Arizona

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