Senior Care Management Coordinator

Job Description:

Coordinates and delivers evidence-based interventions to children 0-5 years old, and their families, who present with social needs and/or developmental concerns.

Job Responsibility

• Implement and sustain the evidence-based Healthy Steps model in supporting families of children ages 0-5 with development, learning and growth, and overall wellbeing, in conjunction with the pediatric primary care team.

• Joins and participates in in-person team-based well visits to reach families during primary care appointments.

• Creates and maintains up-to-date community partnership and resource directory.

• Maintains a Healthy Steps family support line and responds to and track call requests within designated response time.

• Provides appropriate referrals to families for support with individualized needs.

• Appropriately documents all clinical activities and care coordination in the electronic health record with consideration to patient confidentiality.

• Attend and participate in team meetings, huddles, and patient care meetings as appropriate.

• Tracks caseload to ensure capacity to deliver Healthy Steps services within the delivery model. Ensure when termination criteria are met and/ or escalate families requiring further support to higher levels of care through health system and community referrals, as appropriate.

• Use team-based communication strategies to close the loop on referrals and follow up for outstanding patient needs.

• May facilitate caregiver support groups as appropriate.

• Maintains accurate records of caseload data as appropriate for program management, evaluation, and reporting purposes.

• Facilitate reflective clinical supervision meetings.

• Complete chart reviews, review program metrics, and provide clinical supervision to junior members of the Healthy Steps team.

• Contribute to Healthy Steps quality improvement processes and policy frameworks.

Job Qualifications:

• Master’s degree in social work required.

• LCSW licensure required

• 3-5 years of relevant experience working with children and families, required.

• Successful completion of the Healthy Steps Specialist training within 6 months of hire.

**Additional Salary Detail

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).