at Ann & Robert H. Lurie Children's Hospital of Chica in Lake Forest, Illinois, United States
Job Description
Ann & Robert H. Lurie Children's Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children's Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.
Location875 N Michigan (John Hancock)
Job Description
The Social Work Care Coordinator provides coordination, education and outreach services to the Lurie Children's Health Partners Care Coordination (LCHPCC) members and their families/guardians. Primary responsibilities include assessing social service needs and identifying and addressing social barriers to members achieving optimal health care status, such as lack or inaccessibility of housing, transportation, utilities, or food. Additional responsibilities include assisting members in accessing medically necessary specialty care services and ensuring access to appropriate preventive services.
Essential Job Functions:
* Completes Health Risk and psychosocial assessments of assigned members
* Identifies care needs and goals based upon:
Assessment findings
Analysis of claims data
Provider input
LCHPCC member and parent/caregiver expressed goals
Clinical and social data
Review of record, participation in rounds, care conferences and clinician/family contact
*Establishes Care Plan, in conjunction with RN Care Coordinator, members, parents/caregivers and key providers. Plan shall identify:
Essential primary, specialty, and ancillary services and providers
Needed social support and services and identified community-based organizations that can address those needs
Educational needs of participant and/or caregivers to enhance self-management and
Appropriate utilization of providers to address psychological, developmental and/or medical conditions
Potential barriers to meeting goals and plan for mitigating barriers
Individualized disaster preparedness plan
*Assists the RN Care Coordinator in educating families on member's conditions, medical treatments and facilitates members and families becoming increasingly independent in the care of the member.
*Communication:
Works with care team and family to implement care plan
Provides communication link between all involved in case plan
Assures coordination of care in collaboration with Medical team
Collaborates regularly with payors, physicians and other agencies to improve processes and systems related to care coordination
Assures communication with physicians, payers, business office and/or other agencies upon discharge or transfer
Facilitates transition to next phase of care by serving as liaison between settings
* Planning:
Convenes and facilitates Interdisciplinary Care Team (IDCT) meetings to ensure communication and coordination between CCE participant, parent/caregivers, and key healthcare and support service providers
Refers families to resources available to meet identified needs.
Advocates consideration of all options available to assure quality of care in the most cost-efficient manner.
Facilitates processes to assure patients are cared for in the most appropriate setting along the Children's Hospital of Chicago Medical Center continuum
Works closely with medical team in order to care plan goals and timeframes
* Identifies, assesses, and responds to child/family needs; includes in this process (identification, assessment, response) age-specific developmental needs, psychosocial needs, cultural needs, and spiritual needs. Particularly focuses on addressing the social and emotional needs of families that impact on a patient's medical treatment and outcome. These needs may include, but are not limited to, adjustment to illness, poor coping abilities, impairment in parental functioning, guardianship issues, adherence to treatment plan, need for additional resources due to poverty or compromised financial status, substance abuse, cultural differences, death/dying/bereavement, and family welfare (including child abuse and neglect and domestic violence)
* Monitors clinical and functional status of participants through regular face to face contact and convenes IDCT meetings on an ad hoc basis to address gaps in care or barriers to successful implementation of Care Plan
* Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected and disseminated, in accordance with HIPAA requirements
* Is responsible for the assessment and management of families in emergency/crisis situations. This includes dying/death/bereavement; protective services and domestic violence issues, codes, deterioration of child's health status, or other situations deemed emergent by the family or health care team.
* Provides... For full info follow application link.
EEO/AA Employer/Vets/Disability
