- Works across the continuum of care in order to facilitate and promote high quality, cost effective outcomes, focused on the whole patient orientation and self management decision support and aims to minimize any fragmentation of health care delivery.
- Acts as the liaison between the member, the member's support network, treating physician(s), and ancillary providers utilizing a multi-disciplinary approach to assess, identify, plan, health goal setting and measure optimal clinical outcomes.
- Employs behavior change/motivational interviewing skills to assess readiness, health goal setting short and/or long term needs, engage member's plans for change following standard policy and procedures, clinical guidelines and national evidenced based criteria.
- Works collaboratively with the Care Management team, Health Care Analytics, Performance Improvement departments, Health Plans and Brown & Toland physicians and their offices to identify individuals who require care management wellness and prevention services.
- Masters the use of Brown & Toland e-tools to identify and target needs of risk populations.
- Develops of patient outreach activities such as mailings, reports as well as physicians level quality performance reports.
- Support development, implementation and evaluation of any Brown & Toland programs and activities to improve optimal health outcomes.
- Acts as patient advocate responding to and working to resolve patient concerns or barriers.
- Assist in the development, implementation and evaluation of standards of care, policies, procedures, medical review criteria and protocols to improve care management throughout the delivery system and across the care continuum.
- Serve as a resource to members and B&T physicians. Maintains up to date information on community resources, health coaching literature or recommended screenings and community based programs.
- Communicate timely with primary care providers, specialists and any community affiliates to ensure continuum of care.
- LCSW or LISW in California
- EMR Experience (Epic is preferred)
- 1+ Palliative Care as an LCSW or LISW (3+ yrs preferred)
- Ability to communicate well; excellent written skill; ability to identify issues readily and resolve problems; ability to maintain a high volume workload and changing priorities; work well under pressure.
- You are passionate about improving the healthcare experience and want to be part of the Altais mission.
- You are bold and curious- willing to take risks, try new things and be creative.
- You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
- You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
- You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
- You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.
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Social Worker - Oakland, United States - Altais
Description
Job Description
Job DescriptionAbout Our Company
At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include: Brown and Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists.
About Your Team
Are you looking to work with a high performing, fast growing and dynamic Care Management team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 4,000+ physicians, working in over 40 cities in California, caring for more than 500,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.
This position is located in our brand-new Oakland City Center location, or remotely (within the state of California). We are flexible provided you are open to traveling to the Oakland office locations as needed. You must reside in the state of California.
About Your Work
Palliative Care LCSW play a critical role in providing comprehensive and compassionate care to patients facing serious illnesses and their families. Addressing the psychosocial needs of patients: Palliative Care LCSW help patients cope with the emotional and psychological challenges that come with serious illness, such as anxiety, depression, and grief. They provide counseling, support, and resources to help patients and their families manage these challenges and improve their overall well-being.
Palliative Care LCSW will provide support and counseling to patients' families, who often experience significant emotional and practical challenges when a loved one is seriously ill. They will help families navigate difficult decisions, cope with grief and loss, and connect with resources in their communities.
Under limited supervision, the LCSW is responsible for providing care coordination and care management services for Brown & Toland members. Activities include: assessment, identification, planning, implementation of an individualized plan of care, and evaluation of outcomes. Collaborates with internal and external stakeholders in coordinating a plan of care to achieve optimal quality healthcare outcomes for Brown and Toland members.
You Will Focus On:
The Skills And Experience You Bring:
You Share Our Mission & Values:
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, experience, and geographic location. This base pay range is specific to California and can vary based on Bay Area, Metro LA, and Greater California regions which may not be applicable to other locations.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of workday.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.