Social Worker

Summit Health, Inc. Bedford , NH 03110

Posted 2 months ago

About Our Company

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Job Description

At VillageMD, we're looking for a Social Work Care Manager to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

As an extension of the Primary Care Physician's (PCP) care team, Social Work Care Managers are responsible for providing a variety of care management services within a PCP practice(s) or a patient's home, targeting patients identified as high-risk and/or those who are experiencing barriers to meeting their healthcare goals. Principle care management services include, but are not limited to, performing comprehensive assessments, developing patient-centered care plans, and providing episodic and longitudinal care planning.

Integral to our care management team, the Social Work Care Manager will be responsible for addressing Social Determinants of Health (SDOH), addressing the behavioral health needs of patients and families and for monitoring behavior modification in high risk patients through empowerment and teaching of self-management skills. As a new member of our team, you'll work closely with our care team to connect the dots of collaborative patient care.

What are some unique responsibilities that you'll have at VillageMD?

  • Actively engage and collaborate with PCPs and office staff in identifying high-risk patients

  • Employ motivational interviewing skills to elicit optimal member engagement/outcomes

  • Perform comprehensive assessments for both physical and psychosocial risk factors that support individual patient needs while identifying and addressing barriers

  • Communicate assessment findings, care plan goals, interventions and outcomes to PCP, patients and caregivers in a timely manner

  • Maintain a working knowledge of community resources/agencies to address a wide variety of psychosocial needs members may experience

  • Identify and support practice needs for structured on-site care coordination presence in alignment with program models

  • Maintain a core understanding of population management as it specifically relates to high-risk patients

What will make you successful here?

  • The ability to be flexible in an ambiguous and dynamic environment

  • The ability to adapt quickly to changing demands in the healthcare industry

  • A service orientation and a "can do" attitude

  • A willingness to learn on your own and take initiative

  • Displays strength-based approach to collaborative problem solving

  • The ability to receive feedback and apply it to work performance

  • Demonstrates consistently strong ethics and sound judgement

  • Effectively engages diverse populations (age, ethnic groups, socio-economic levels, etc.) and provides culturally sensitive coaching, education and assistance to members and their families

  • Experience in conflict management and problem resolution

  • A low ego and humility; an ability to gain trust through strong communication and doing what you say you will do

What you might do in your first year:

  • Address gaps in care for high risk patients engaged in care management services

  • Utilize behavioral health screening assessments, identify symptoms of behavioral health and substance abuse concerns, and effectively make referrals to appropriate community resources

  • Effectively support patients, families and caregivers in managing psychosocial barriers

  • Document clinical interventions in applicable care management software systems

  • Develop and maintain effective professional working relationships with assigned PCP practice(s)

  • Engage patients in a variety of settings, determined by program models and initiatives

The following experience is relevant to us:

  • Master's degree in social work or a related discipline

  • Licensed Clinical Social Worker with licensure in the state of practice

  • 2+ years of experience in a health care and/or behavioral health setting

  • Experience working in a SNF (Skilled Nursing Facility), discharge planning, and/or working in a hospital setting preferred

  • Foundation of social work ethics that informs a thoughtful, evidence-based approach

  • Utilizing a variety of electronic health records including data capture, data mining and reporting

About Our Commitment

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.


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