Title: Community Care Team HOME Care Manager Social Worker

          Territory: Mid coast/Southern Maine & Martins Point Health Care

 

What You’ll Do:

Care Manager Social Worker will, in collaboration with the primary care practice, coordinate services using a systematic and cost-effective approach to provide patient-centered care for a defined population. The Care Manager will engage the patient to reduce unnecessary health care services and improve their overall health and well-being. A specialized focus on housing support will be provided to HOME enrolled patients.  Care Manager to work with each practice to assess the gaps in care coordination as well as patients’ access to and utilization of community supports. The Care manager will need to collaborate with designated physician practices and community partners to determine the best model for addressing the needs of the most complex patients. Work with patients with complex emotional-social issues and mental health concerns. Work with CCT, primary care provider, and Mainecare to identify recipients who are most likely to benefit from care management intervention and agree to participate.  Care manager may make patient visits prior to hospital discharge, in the primary care practice, in the home or public setting. 

What You’ll Bring:

Current Social Worker licensure or conditional Social Work licensure in the State of Maine.Must have a reliable automobile.Must have current Maine driver’s license.Independent malpractice insurance strongly advised.Evidence of automobile insurance.Must submit current licensure every two years to Human Resources Dept., before expiration date.Must be proficient in use of computers and adept at learning new programs.