Social Worker Care Coordinator – Population Health

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🌽 Illinois, Kentucky, +1 more states – Remote

🌽 Illinois – Remote 🐎 Kentucky – Remote 🏈 Ohio – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Mercy Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Mercy Health is a mission-driven healthcare organization that provides direct patient care, community health services and a range of support and administrative roles. The organization emphasizes the human side of health care, compassionate, values-based service tied to a ministry mission, workforce development for bedside and support staff, flexible benefits and community outreach. Mercy Health positions itself as both an employer and community health provider focused on dignity, unity and social service.

📋 Description

• Provide clinical care management services to eligible patients to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care • Work with the Interdisciplinary Team, Ambulatory Care Manager, and Care Coordinator to identify and address patient needs • Perform standardized comprehensive needs assessments and address barriers to care • Maintain a patient caseload according to department policies • Identify, enroll, and manage patients in Complex Case Management • Develop, implement, periodically review, and update patient-centered care plans • Collaborate with ACMs, PCPs, specialists, and hospitalists • Assess social determinants of care and develop goals • Conduct patient outreach and document in the electronic medical record • Identify, execute, and track referrals to care and community resources • Manage resources to improve care, patient experience, and reduce unnecessary cost and utilization • Assist patients with advanced care planning and Advanced Directives • Document communications with patients and care teams in the electronic medical record • Coordinate services for disabled status and facilitate placement in post-acute rehabilitation or long-term care facilities • Advocate for patients and connect them with appropriate community resources and services

🎯 Requirements

• Bachelor’s Degree required • Master’s Degree or licensure as required by state of practice required • 2–3 years of acute care, home health, or case management experience • Excellent interpersonal communication and negotiation skills • Strong analytical, data management, and computer skills • Basic knowledge of healthcare and health education across the lifespan in a practice health setting • Ability to work with individuals, groups, and families • Familiarity with Community Resources • Flexibility to work non-traditional hours • Ability to work in a team setting • Personal computer skills • Experience with database entry and EMR documentation • Basic Excel skills • Highly organized and detail-oriented • Ability to accept responsibility and follow through on projects and activities • Case Management certification, LSW, or LCSW preferred • Experience with PowerPoint preferred • Demonstrated success improving the health of a distinct patient population in an ambulatory or community setting preferred

🏖️ Benefits

• Competitive pay • Incentives • Referral bonuses • 403(b) with employer contributions (when eligible) • Medical coverage • Dental coverage • Vision coverage • Prescription coverage • HSA/FSA options • Life insurance • Mental health resources and discounts • Paid time off • Parental leave • FMLA leave • Short-term disability • Long-term disability • Backup care for children and elders • Tuition assistance • Professional development • Continuing education support