Social Worker 1

Job Summary

The Clinical Case Manager (CCM) will provide clinical case management/coordination services and focused disease education to patients of the AU Ryan White Program.

The incumbent will promote coordinated, high quality, and cost-effective outcomes for assigned caseloads. The CCM develops individualized service plans (ISP) to facilitate self-monitoring and self-management skills of health conditions and improve function and quality of life. The ISP will consist of at minimum: Medical History/Physical Health Status, Medical Treatment Adherence and Appointments Adherence, Health Insurance, Family/Domestic Situation, Housing Status, Source of Income, Nutrition/Food, Mental Health, Substance Abuse, Personal and Community Support Systems, Disclosure, Risk Reduction, Legal Issues, Transportation, Cultural Beliefs and Practices/Languages, and any additional service needs. The ISP will be revised at least every six months. The incumbent will be an advocate for appropriate resources available in the community and across the continuum of care to best meet the needs of the client. This role will interact with all levels of personnel, medical staff, patients, community resources, providers and families. This role will include providing all necessary patient referrals both in-house and external.

Responsibilities

The responsibilities include, but are not limited to:

Initial screening and maintaining eligibility for RWHAP services residency, income, and insurance statuses continue to meet the grantee eligibility requirements and to verify that the RWHAP is the payer of last resort, annually. The recertification process includes checking for the availability of all other third-party payers. All indigent patients will be screened and enrolled into the hospital's indigent care program ICTF. All eligible Ryan White patients will be screened and enrolled into Georgia and South Carolins AIDS Drug Assistance Program ADAP and the Healthcare Insurance Continuation Program HICP. ADAP and HICP recertification will take place annually. All insured patients will be screened and offered enrollment into AU Ryan White 340B Program for co-pay and deductible assistance. Insured patients will also be screened for drug pharmaceutical co-pay assistance programs and the Patient Advocate Foundation (PAF).

Ability to effectively engage patients by telephone or direct contact in clinic/office settings to conduct thorough screening, physical and psychosocial assessments in a timely manner per policy. Consistently collaborates with patients and family, physicians and other health care team members to identify physical and psychosocial issues or barriers that affect health condition management. Implements a comprehensive patient-centered plan of care to proactively manage these issues and effect positive health outcomes. Prioritizes caseload to balance patient and departmental needs. Acts as a patient advocate and coordination link with other health care providers and community resources to positively impact outcomes. Advocates for the patient to overcome barriers and resolve benefit issues. Assist patients to navigate healthcare system and insurance benefits.

Thoroughly assesses each patient's eligibility for needed resources Identifies barriers or gaps in treatment. And refers to the appropriate team member to address the need as indicated to holistic care and positive outcomes. Stays abreast of community resources and refers the patient for services and assistance when appropriate. Willingly collaborates with health care team members to formulate an individualized care plan and goals that best meet the needs of the family/patient. Utilizes motivational interviewing techniques to engage patients in goals setting. Updates care plan to articulate current short-term and long-term goals as well as when these goals are met and /or revised. Consistently documents accurate and timely information in Electronic Medical Record as per policy. Consistently communicates with the health care team members to ensure patient care needs are addressed in a timely manner. Communicates care coordination and key elements to provider per department requirements.

Utilize a variety of approaches to effectively educate patients/families as well as other members of the health care team regarding community resources, health care benefits, insurance and managed care issues. Provides health education to patients and family members to assist in disease management and the development of coping skills. This includes information on disease processes, medications, treatment plans and preventive measures, and advanced directives. Follows-up to evaluate the effectiveness of education provided and documents. Participates in multidisciplinary patient care conferences as needed. Consistently and accurately document health education activities in the documentation systems per department requirements. Appropriately updates department leadership with necessary information.

Proactively identifies barriers to adherence and acts promptly to revise the treatment plan to improve patient adherence and outcomes. Takes prompt action when issues involving the appropriate and cost-effective utilization of resources are identified, collaborating with appropriate health care team members. Confers with the patients/families, physicians and other care providers and insurance carriers in the role of patient advocate, as need to resolve benefit issues and secure necessary services.

Consistently documents all care management activities in the Electronic Medical Record(s) and or software application using the established format in a timely and accurate manner per department requirements. Promptly sends reports and communications to physicians and other providers as per department requirements and as needed to relay pertinent findings. Actively participates in program improvement activities.

Performs other job duties and responsibilities as required.

Required Qualifications

Bachelor's degree from accredited college or university in Social Work, Nursing, Public Health, or related field from an accredited college or university is required.

Knowledge, Skills, & Abilities

ABILITIES

Ability to adapt effectively to changing priorities; care and manage diverse populations without applying one's own personal values; and work with minimal supervision within scope of practice.

Ability to maintain confidentiality; successfully articulate the process of attaining goals and outcomes of medical case management; apply clinical knowledge in a medical case management role; engage and collaborate with the patients and significant others in the medical case management process; and apply HIPAA during the medical case management process.

KNOWLEDGE

Proficient in Microsoft Office and other computer software/databases.

Knowledge of medical case management concepts along the care continuum, Medicare benefits, and HIPAA.

Understand and comply with regulations and recommendations of outside regulatory bodies with regard to providing case management role.

SKILLS

Excellent interpersonal, verbal, and written communication skills.

Detail-oriented with strong organizational, prioritization, critical-thinking, analytical and multi-tasking skills.

Shift/Salary/Benefits

Shift: Days/M-F

Pay Band: B10

Salary Minimum: $25.24/hour

Salary to be commensurate with qualifications of the selected candidate within the established range (generally minimum-midpoint) of the position.

Recruitment Period: 4/27/26 - Until Filled

Augusta University offers a variety of benefits to full-time benefits-eligible employees and some of our half-time (or more) employees.

Benefits that may be elected could include health insurance, dental insurance, life insurance, Teachers Retirement System (or Optional Retirement Plan), as well as earned vacation time, sick leave, and 13 paid holidays.

Also, our full-time employees who have been employed with us successfully for more than 6 months can be considered for the Tuition Assistance Program. Consider applying with us today!