OHSU Health Services is committed to the ongoing journey of being an anti-racist organization that acknowledges the enduring impacts of historical injustices on health; addresses clinical, social, and structural systems and conditions that undermine health and wellness; strives to become a culturally-proficient workplace that reflects the communities served; and fosters an environment of belonging, respect, and inclusion where everyone feels empowered and safe to bring their full, authentic selves to the work. Change requires individuals at all levels of the organization to be proactive in redistributing resources and power equitably by restructuring policies, clinical and financial strategies, culturally sensitive data analysis and the way data is used. OHSU Health unequivocally expects its staff and leadership to fully support this mission in these efforts.
The Integrated Community Care Manager Social Worker (ICCM-SW) is an integral member of the multi-disciplinary Care Integration and Coordination Program. The ICCM-SW provides on-site (face-to-face) and telephonic outreach, behavioral health, disease and/or care management, care coordination, education, support and navigation to OHSU Health Services Members with the goal of supporting healthy life choices and to reduce long term effects of chronic illness. The individual in this role performs other clinically based activities to assist in the coordination of care between the member, his/her provider(s), health care facilities, and community-based health organizations. The ICCM-SW offers social work intervention and coordination of needed services to Members and/or families experiencing psychosocial adjustment difficulties associated with illness, injury, disability and related hospitalization and or health care interventions. The ICCM-SW enhances the quality of Member management by promoting continuity of care and cost effectiveness through whole person care management, care integration, and care coordination across the continuum of health care services.
Salary Range: $86,367.32 - $130,783.12
Master’s in Social Work required with a Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required.
Clinical assessment skills, consistent with state licensure scope of practice.
Minimum two (2) years of clinical experience.
Prior experience in case management.
Knowledge and experience working within Epic as the electronic medical record.
Knowledge of Medicare and Medicaid.
Knowledge of adult learning and behavior change principles.
Knowledge of community-based resources.
Demonstrated skills in motivational and health coaching, patient advocacy, health promotion, disease prevention, patient education and resource management.
Demonstrates knowledge of NQCA and Case Management guidelines.
Provides care management services appropriate to the age of the member served – neonate, infant, pediatric, adolescent, adult and geriatric patients based on the principles of growth and development and life stages.
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