Coordinate and participate in home visits and care conferences involving the member, their supports, and providers
Collaborate with RNCM to coordinate acute and primary care services, care transitions, and related follow-up care
Conduct in-person comprehensive, strengths-based assessment of the member's outcomes, needs and risks; perform reassessment as condition changes
Develop, coordinate, monitor and evaluate the members’ outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers
Implement risk mitigation strategies to promote the member’s health, safety and independence while respecting the member’s rights to appeal and grieve
Maintain member records as required by DHS contract and LCI policy
Build and maintain an effective and collaborative working relationship with RNCM partner and various departments/stakeholders
Participate in team meetings and on-going trainings to stay abreast of policies, procedures, and state/federal regulations
Maintain the confidentiality of member information and protected health information (PHI) in accordance with HIPAA and state/federal regulations
Arrange for provision of services and supports based on comprehensive assessment and monitor provision via IDT
Requirements
Certified Social Worker in the State of Wisconsin with a minimum of one (1) year experience working with at least one of the family care target populations
OR A four-year bachelor’s degree or more advanced degree in Human Services or related field with one (1) year experience working with at least one of the family care target populations
OR A four-year bachelor’s degree or more advanced degree in any other area than Human Services with a minimum of three (3) years’ experience working with at least one of the family care target populations
Working knowledge of computers, computer programs, typing, and data entry
Ability to access members’ homes which are not required to comply with the ADA regulations
Ability to multi-task and work in a fast-paced environment
Ability to lift up to 25lbs
Current driver’s license, acceptable driving record and proof of adequate insurance
Position requires traveling in the field/community visiting members
Maintain confidentiality of member information and protected health information (PHI) in accordance with HIPAA and state/federal regulations
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