Care Coordinator - Social Work - Outpatient Clinic
at La Rabida Children's Hospital

Date Posted: 5/8/2019

Job Description

1 Full-time position

1 Part-time position (20 hours per week)

Perform various delegated direct and indirect patient care activities which can include working directly with patient and family that are members of the La Rabida Medical Home Program. Additionally, complete various organizational and payer-related compliance audits, maintains and runs reports that support La Rabida’s Medical Home program and its patient panel care coordination. Provide administrative support for integrated care teams that provide oversight of the overall care coordination for the patients within the La Rabida primary care clinics. Assist in maintaining external relationships with referring organizations, payers, vendors and regulatory entities.

1.      Coordinates and performs the day-to-day care coordination activities for patients with care coordination needs, consistent with each patient’s individualized plan of care, La Rabida standards of care, and all applicable care coordination policies and procedures.  Care coordination activities include, but are not limited to:

a.      Conducting health risk assessments (HRA)

b.      Developing individualized plans of care (IPOC)

c.       Facilitating and supporting communication between members of La Rabida’s integrated care team (ICT), patients, and other relevant stakeholders to the patient’s health and well-being

d.      Providing patients with information, referrals, and assistance accessing resources such as food, housing, utilities, transportation, school intervention/consultation/early intervention, legal advocacy, guardianship/custody support, home health/long-term care support, durable medical equipment (orders and training/implementation), mental health services, palliative/hospice care, and other sub-specialty services

e.       Contacting patients and providers to assist in scheduling appointments, ensuring patients complete steps to obtain prior authorizations, following-up on missed appointments, and monitoring patient attendance for purposes of identifying and addressing barriers to consistent engagement in services

f.        Regularly monitoring patient compliance and progress regarding their IPOC, communicating this information to the ICT and other relevant stakeholders for feedback and consultation, and updating the IPOC as needed to address barriers to patient wellness.

g.      Monitors and alerts the ICT and other relevant stakeholders of a pending (planned) or completed (unplanned) change in patient level of care and works with these groups and the patient and other relevant stakeholders to develop a transition of care plan

h.      Completing discharge plans (from care coordination services) in consultation with the patient, the ICT, and other relevant stakeholders

2.      Initiates child welfare intervention/support as needed

3.      Performs telephonic and in-clinic crisis management as needed

4.      Conducts clinical screening/assessments as needed

5.      Provides and documents care coordination services for all assigned cases consistent with quality, productivity, and timeliness standards established by La Rabida care coordination leadership

6.      Responsible for running reports and compiling data to facilitate each assigned patient’s compliance with their individualized plan of care

7.      Successfully participates in all mandatory training for care coordinators and renews training certification as required by La Rabida policy, payor contractual guidelines, or State/Federal regulations

8.      Frequently navigates multiple electronic health records for purposes of research, documentation, and data submission/collection/reporting  

Job Requirements

  • BA/BS in social work or related field required.
  • 3 years of work with children and families required.
  • Early Intervention experience strongly preferred
  • Previous care management/coordination experience in an ambulatory/hospital setting strongly preferred
  • Early Intervention certificate preferred or eligible to obtain
  • Evaluation credential from Early Intervention preferred or eligible to obtain within one year
  • Excellent communication and interpersonal skills required
  • Demonstrated knowledge of service delivery systems and resources for children and families required
  • Demonstrated ability to develop and implement plans of care required
  • Knowledge of medical social services and community services in the Chicago area preferred
  • Organized and motivated self-starter required
  • Experience in Microsoft Office, Word/Excel required

Job Snapshot

About Us

La Rabida Children’s Hospital is the only is the only hospital of its kind in Chicago.  We specialize in treatment of chronic illnesses, developmental disabilities, abuse and trauma.  La Rabida provides comprehensive, interdisciplinary health services to children across a continuum of care, serving as a model for family-centered care.

La Rabida is a very special place.  Triumphs occur here. Children overcome odds and excel beyond hope. This is where those who serve gain more than they give. La Rabida offers rewarding job opportunities across a wide array of clinical, administrative and support service functions. We also offer psychology training programs in child clinical and pediatric psychology.

Our comprehensive employee benefits program is competitive. Our lakefront location is spectacular. We are an equal opportunity employer. We promote healthy eating and our facilities are smoke free.

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