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  • Conduct telephonomic assessments of members' medical, psychosocial, physical, and spiritual needs.
  • Develop and revise Person-Centered Service Plans (PCSP) in response to changes in member condition.
  • Collaborate with interdisciplinary care teams and educate members on Advanced Directives and Health Care Proxy.

Social Work Care Planning Assessment

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  • Provides telephonic and in-home assessments of members' medical, psychosocial, physical, and spiritual needs.
  • Develops, implements, and monitors care plans to ensure continuity of care and chronic care benefit management.
  • Demonstrates strong assessment, communication, interpersonal, and crisis intervention skills in an interdisciplinary environment.

MJHS Home Care provides Medicare and Medicaid managed care health plans designed to help people stay independent. They foster a supportive community committed to excellence, respect, and personalized health care services.

$79,386–$100,000/yr
US

  • Oversee the Care Navigation program, ensuring efficient operation and successful implementation of new programs.
  • Manage relationships with health plan partners and oversee internal policies and procedures for care navigation activities.
  • Provide telephonic care navigation services to individuals receiving services through various programs as needed.

Mom's Meals is a provider of home-delivered meals. They focus on delivering medically tailored meals to individuals with chronic health conditions. The company values its team members and strives to show it through benefits and other offerings.

4w PTO

  • Monitor high-risk pediatric patients, ensuring appropriate follow-up and assistance with meeting resource needs.
  • Conduct comprehensive assessments to address behavioral, social, emotional, and systemic needs of patients and families.
  • Perform daily tracking of family needs, continuously evaluate the effectiveness of the patient/family care map, and modify plans based on evolving needs.

Imagine Pediatrics is a tech-enabled, pediatrician-led medical group that reimagines care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.

US

  • Collaborate with interdisciplinary team members to deliver comprehensive virtual care services to patients.
  • Provide support for patients and families coping with life transitions, chronic illnesses, and other psychosocial challenges.
  • Develop and implement individualized care plans that address patients' needs, connecting them with relevant community resources.

Interwell Health is a kidney care management company that partners with physicians. They aim to reimagine healthcare and set the standard for the industry to help patients live their best lives. They are committed to diversity, equity, and inclusion throughout their recruiting practices.