Overview The M Health Fairview Care Coordination team has an opening for a Social Work Care Coordinator to support patients within M Health Fairview Rice Street Clinic.  This is a 1.0 FTE (80 hours per two week pay period), benefits-eligible opening. M Health Fairview offers a competitive benefits package including medical/dental, 401k/403b with employer match, tuition reimbursement, and PTO! Click here for benefits details. This position is a mobile position structured as a hybrid schedule with two days on site and three remote days per week.  On site clinic location(s) could be rotated and discussed upon hire, providing flexibility.  Core hours are Monday-Friday 8-4:30pm. Responsibilities Job Description The incumbent provides a wide range of social work services and interventions to assist individuals, families, groups or communities to restore, enhance, or protect their capacity for productive social functioning and coping with their illness and health care status. The individual is able to work independently and takes a role in patient care, program and professional issues that they confront in their daily practice with minimal supervisory guidance. This position provides a wide range of clinical social work support and interventions across the Fairview system, to assist patients and families as they transition through an episode of care. This position supports patients and families in coping with the consequences of their illness and health care status. This position takes a leadership role in patient care, program and professional issues that they confront in their daily interactions, and supports the transition of patients along the health care continuum. Duties Include: Provides a range of clinical social work interventions that include advocacy, casework, counseling, crisis intervention, and care transitions management in assisting patients and families to reach their goals. Plans and implements interventions and transition planning based upon psychosocial and risk assessments that are integrated into the patient’s plan of care. Initiates/implements transition functions and activities for patients, communicating with patients, families and the health care team to ensure seamless transitions. Determine if caregiver training is needed. Arranges and coordinates a comprehensive range of community resources; maintains up-to-date knowledge regarding resources and current financial information. Takes a leadership role in facilitation of interdisciplinary communication, guiding interdisciplinary team member interactions with patient/families experiencing complex psychosocial issues. Identifies and initiates appropriate system change to enhance patient and family satisfaction. Effectively communicate transition plans across the continuum of care. Partners with inpatient/outpatient care team on patient care issues. Takes leadership in revising or restructuring program or service standards as needs change.. Acts as social work consultant to various levels of consultees to problem-solve complex patient care situation.Mentors internal members of the health care team on care transitions concepts. Facilitates integration of concepts into daily practice. Understands and focuses on key performance indicators. Actively tracks outcome and participates in quality planning Qualifications Required Bachelor’s Degree in Social Work Current MN Social Worker Licensure (MN Board of Social Work) Preferred Prior experience with Epic EMR One or more years' prior acute care experience Other Skills We Desire: Excellent customer service, public relations and communication skills Ability to prioritize and work with a fluctuation in workload while working independently Ability to adapt to change and engage in ongoing process improvement Flexibility to work at other sites is encouraged We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, sex, gender, gender expression, sexual orientation, age, marital status, veteran status, or disability status. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation. EEO Statement EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status