University of Rochester CHH Care Manager - 220800 in Rochester, New York
CHH Care Manager
Strong Memorial Hospital
Full Time 40 hours Grade 051 Social Work Division SMH
The Care Manager provides comprehensive, care management services in collaboration with the child's care team to a caseload of children assigned by GRHHN or CHHUNY to the GCH@S Health Home Program. Upon receiving assigned children, the Care Manager will engage, enroll, assess develop and implement a care plan that addresses the child's medical, behavioral, and psychosocial needs and goals.
Intake referred patients by completing a Children's Health Home consent and by engaging the patient/family in the completion of the CANS- NY assessment.
Utilizing information obtained from the CANS and in partnership with the family, develops a preliminary care plan. Care plans will address the unique needs of the child to include physical and mental health, growth and development, education, parenting, safety, stability of the home environment, trauma, and social relationships.
Review care plans with the child's care team to assure a shared vision of the goals and issues to be addressed and strategies for meeting goals.
Document consent, CANS and care plan in the Netsmart care manager data base.
Meet with child/family at intervals that promotes progress on the care plan, meets HH expectations, allows for continuous engagement and offers a level of support needed. Face to face meetings can include home visits, at medical appointments or at community service locations. Continually address barriers for child's utilization and compliance with health and behavioral health needs including transportation, housing, insurance, life sustaining resources and referrals to other community resources/services. Document all activities in the Netsmart system.
Assume primary responsibility for care coordination with primary, specialty, and behavioral health providers, PCMH care coordinators discharge coordinators, home health care, MCO case managers, CPS, and other involved providers of service.
Establish liaison relationships with a broad array of fo1mal and informal community services that offer resources for the Children's Health Home population.
Monitor emergency room visits and hospitalizations and reassess service plans as indicated based on these encounters as well as every six months of enrollment.
Identify and report suspicions of child abuse or neglect according to SMH and Social Work Division policy.
1Prepare for and participate in regularly scheduled supervision and bring all critical clinical and administrative issues immediately to the attention of the assigned supervisor.
Complete all required documentation within set time frames and according to Health Home, Hospital and Social Work Division standards.
Coordinate and facilitate care conferences.
Attend staff and team meetings.
Provide statistical reports and other information relating to productivity and quality assurance activities.
Provide clinical coverage in the absence of co-workers.
May transport a patient with a family member on occasion if needed to meet a care plan goal.
Participate in on- call rotation for Children's Health Home Program
Complete all required mandated trainings and certification in the CANS, health updates, time reporting and ongoing professional development with focus on cultural sensitivity, patient engagement, motivational interviewing, self-management, health promotion, disease management and other areas related to scope of services.
Professional Accountability, Supervision and Evaluation:
The Care Manager is supervised by an LMSW Social Worker, by whom the professional performance evaluation is done with input from collaborating partners. This evaluation is conducted at six months and annually thereafter. Annual salary is determined by the Social Work Clinical Manager for Pediatrics, in conjunction with the Director of the Social Work Division, Strong Memorial Hospital. The Care Manager is clinically and professionally accountable to the supervisor (and through the supervisor) to the Clinical Manager for provision of services and adherence to Hospital, Social Work and Health Home policies, procedures and standards of professional conduct.
Any change in clinical responsibilities in this position must be authorized by the Director of the Social Work Division upon the recommendation of the Clinical Manager.
The Care Manager must have a BSW or bachelor degree in a human service field or considerable experience in providing care management services within the community via home visits and a minimum of two years of relevant experience in community based work with diverse populations. In addition, the Care Manager must have a registered vehicle and requisite insurance as well as a current driving record which reflects the UR Safer Driving program standards in order to transport clients.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled