Social Worker Field Case Manager

About Horizon Case Management CORP

At Horizon Case Management Corp, we are dedicated to providing compassionate, patient-centered care that enhances the lives of individuals in our community. As a leader in healthcare case management, we specialize in coordinating care services to ensure that patients receive the support they need to achieve the best possible health outcomes.

Our team is made up of experienced professionals who work collaboratively to address the medical, social, and emotional needs of each patient. We prioritize a holistic approach to care, empowering individuals and families with the tools and resources they need to make informed decisions about their health and well-being.

We believe in creating a supportive and inclusive work environment where all employees are valued, respected, and encouraged to grow professionally. At Horizon Case Management, we are committed to making a meaningful impact in the lives of our patients and the communities we serve.

We are seeking a compassionate and dedicated Social Worker Field Case Manager to join our dynamic healthcare case management team. In this role, you will work under a Certified Case Manager and alongside a Registered Nurse Telephonic Case Manager. Your day-to-day will be directly in the field, meeting our clients at medical appointments to advocate for their health needs, assessing patient needs, developing care plans, and coordinating resources to ensure optimal health and well-being. The ideal candidate will have strong social work skills, excellent communication abilities, and a deep commitment to advocating for the holistic care of patients in a community setting.

Key Responsibilities :

• Patient Assessment :
• Conduct comprehensive in-home or field-based assessments to evaluate patients' social, emotional, and healthcare needs.
• Collaborate with patients, family members, and healthcare providers to develop and implement individualized care plans that address both healthcare and psychosocial needs.
• Care Coordination :
• Facilitate access to community resources, mental health services, social support, and necessary healthcare services for patients in the field.
• Stay informed of local community programs and services to ensure effective coordination of care and seamless access for patients.
• Patient Support and Education :
• Provide social work support, education, and emotional guidance to patients and their families during in-home visits.
• Empower patients to make informed decisions about their health, including providing resources on coping strategies and community support options.
• Monitoring and Evaluation :
• Regularly monitor patients' progress in the field and adjust care plans as necessary to ensure optimal health outcomes.
• Maintain accurate and confidential documentation of patient interactions and case updates in compliance with organizational policies.
• Interdisciplinary Collaboration :
• Work closely with healthcare professionals, including physicians, nurses, and therapists, to provide comprehensive, patient-centered care.
• Actively participate in team meetings to discuss patient progress and ensure coordinated care efforts across disciplines.
• Advocacy and Education :
• Advocate for patients' social and healthcare needs and assist in navigating community and healthcare resources.
• Educate patients and families on healthcare processes, rights, and available support services.
• Advocate for resources and removal of barriers.
• Training and Development :
• Participate in ongoing professional development to stay current on the latest social work practices, case management strategies, and community resources.
• Share insights, best practices, and case studies with team members to improve the quality of care.
• Additional Responsibilities :
• Handle any situations that arise dealing with Adult Protective Services, Child Protective Services, and manage Legal Guardianship and Power of Attorney processes for clients.
• Manage residential placements for clients, including finding programs or housing such as low-income housing and adult foster care homes.
• Be knowledgeable in Medicaid Waiver Programs, VA Programs, and other relevant community support systems.
• Be familiar with food programs, addiction programs, mental health programs, pregnancy support programs, and other community-based resources.

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What We Offer :

Horizon Case Management is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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