Master Social Worker - MSW
Fresenius Medical Care, Rolling Meadows, IL, United States
Purpose and Scope
The Care Navigation MSW promotes ongoing care coordination, problem solving, and customer support to enhance patient care for Fresenius Health Partners (FHP) Care Navigation population. The role monitors and intervenes with patients at high risk of poor health outcomes, poor adherence to treatments, and complex psychosocial barriers. Psychosocial services are provided using Social Work Theory of Human Behavior and accepted social work practice methods. The MSW collaborates with the interdisciplinary team to educate and support staff in understanding the emotional and behavioral impacts of Chronic Kidney Disease, ensuring comprehensive care. Services are primarily telephonic, with occasional on‑site visits to clinics, medical offices, hospitals, or patient homes as required. The MSW maintains a database of all interactions and supports a positive rapport with patients, affiliated providers, and vendors.
Principal Duties and Responsibilities
Drive the FMCNA culture through values and customer service standards.
Maintain outstanding customer service for all external and internal customers.
Develop and maintain effective relationships through timely communication.
Initiate action to resolve and follow up on customer service issues promptly.
Use defined trigger events to initiate outbound communication with patients, families, and other concerned parties, facilitating care coordination for patients assigned to the Care Navigation unit.
Handle referrals from Care Navigation unit staff, patients/families, or dialysis clinic staff regarding patients at high risk of poor health outcomes, non‑adherence to treatment recommendations, or complex psychosocial barriers. Identify root causes, develop intervention plans, execute interventions with team members, monitor success, and re‑evaluate as necessary.
Apply established social work theory and quality of life measurement instruments for assessment and care planning to resolve barriers and meet patient treatment goals.
Provide outcome‑driven psycho‑educational counseling to improve treatment adherence, vocational/educational rehabilitation, and quality of life.
Educate patients/families about psychosocial issues related to End Stage Renal Disease (ESRD) and available support services.
Collaborate with clinical staff and other health care team members to develop an individual plan of care, facilitating an immediate action plan to address current needs.
Communicate and coordinate with patients and appropriate health care team members to develop, execute, and review care coordination efforts, closing the loop.
Navigate and refer social services and community resources, including emergency food, housing, shelter, or transportation.
Identify suitable community social service agencies and other resources to assist patients and families, such as securing financial assistance or medical transportation.
Assist clinics in identifying and managing interventions for patients at risk of poor health outcomes.
Collect, review, and employ all pertinent information from FMC clinical systems, care management notes, vendor information, geographic mapping software, and direct communication with patients, physicians, and other team members.
Report to clinical staff any unreported medical or social conditions that may lead to adverse outcomes, ensuring referral to appropriate sources.
Maintain and update the appropriate software and tracking logs for patients in the Care Navigation Program.
Evaluate program processes and recommend improvements to enhance effectiveness and efficiency.
Maintain the integrity of Protected Health Information (PHI).
Comply with departmental data collection and auditing activities, participate in quality improvement activities, and engage in project‑based work.
Stay current with departmental program software and the company’s clinical information systems.
Improve job‑related capabilities through continuing education, professional seminars, and technical workshops.
Assist with various projects as assigned by the direct supervisor.
Other duties as assigned.
Review and comply with the Code of Business Conduct and all applicable company policies, local, state, and federal laws, and regulations.
Assist with various projects as assigned by the direct supervisor.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location‑specific functions.
Physical Demands and Working Conditions
The physical demands and work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
Education
Masters of Social Work required.
Experience and Required Skills
2 to 5 years of related experience.
Social Work licensure required.
Minimum of two years of experience in health care customer service or Nephrology patient care within a physician office, dialysis center, or other medical environment.
Clear and persuasive patient communication skills.
Successful problem‑solving experience.
Excellent verbal, written, and presentation skills.
Short‑task project management experience.
Familiarity with MS Word, Excel, PowerPoint, and computer user interfaces.
Organized and detail‑oriented with a strong bias for follow‑up and problem resolution.
Proven ability to be a team player.
Compensation
Rate: $XX - $XX (dependent on work location and qualifications).
Benefits
Benefit Overview: Comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave, and potential for performance‑based bonuses.
Drug‑Free Workplace
Fresenius Medical Care maintains a drug‑free workplace in accordance with applicable federal and state laws.
Equal Opportunity Employer
EOE, disability/veterans
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The Care Navigation MSW promotes ongoing care coordination, problem solving, and customer support to enhance patient care for Fresenius Health Partners (FHP) Care Navigation population. The role monitors and intervenes with patients at high risk of poor health outcomes, poor adherence to treatments, and complex psychosocial barriers. Psychosocial services are provided using Social Work Theory of Human Behavior and accepted social work practice methods. The MSW collaborates with the interdisciplinary team to educate and support staff in understanding the emotional and behavioral impacts of Chronic Kidney Disease, ensuring comprehensive care. Services are primarily telephonic, with occasional on‑site visits to clinics, medical offices, hospitals, or patient homes as required. The MSW maintains a database of all interactions and supports a positive rapport with patients, affiliated providers, and vendors.
Principal Duties and Responsibilities
Drive the FMCNA culture through values and customer service standards.
Maintain outstanding customer service for all external and internal customers.
Develop and maintain effective relationships through timely communication.
Initiate action to resolve and follow up on customer service issues promptly.
Use defined trigger events to initiate outbound communication with patients, families, and other concerned parties, facilitating care coordination for patients assigned to the Care Navigation unit.
Handle referrals from Care Navigation unit staff, patients/families, or dialysis clinic staff regarding patients at high risk of poor health outcomes, non‑adherence to treatment recommendations, or complex psychosocial barriers. Identify root causes, develop intervention plans, execute interventions with team members, monitor success, and re‑evaluate as necessary.
Apply established social work theory and quality of life measurement instruments for assessment and care planning to resolve barriers and meet patient treatment goals.
Provide outcome‑driven psycho‑educational counseling to improve treatment adherence, vocational/educational rehabilitation, and quality of life.
Educate patients/families about psychosocial issues related to End Stage Renal Disease (ESRD) and available support services.
Collaborate with clinical staff and other health care team members to develop an individual plan of care, facilitating an immediate action plan to address current needs.
Communicate and coordinate with patients and appropriate health care team members to develop, execute, and review care coordination efforts, closing the loop.
Navigate and refer social services and community resources, including emergency food, housing, shelter, or transportation.
Identify suitable community social service agencies and other resources to assist patients and families, such as securing financial assistance or medical transportation.
Assist clinics in identifying and managing interventions for patients at risk of poor health outcomes.
Collect, review, and employ all pertinent information from FMC clinical systems, care management notes, vendor information, geographic mapping software, and direct communication with patients, physicians, and other team members.
Report to clinical staff any unreported medical or social conditions that may lead to adverse outcomes, ensuring referral to appropriate sources.
Maintain and update the appropriate software and tracking logs for patients in the Care Navigation Program.
Evaluate program processes and recommend improvements to enhance effectiveness and efficiency.
Maintain the integrity of Protected Health Information (PHI).
Comply with departmental data collection and auditing activities, participate in quality improvement activities, and engage in project‑based work.
Stay current with departmental program software and the company’s clinical information systems.
Improve job‑related capabilities through continuing education, professional seminars, and technical workshops.
Assist with various projects as assigned by the direct supervisor.
Other duties as assigned.
Review and comply with the Code of Business Conduct and all applicable company policies, local, state, and federal laws, and regulations.
Assist with various projects as assigned by the direct supervisor.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location‑specific functions.
Physical Demands and Working Conditions
The physical demands and work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
Education
Masters of Social Work required.
Experience and Required Skills
2 to 5 years of related experience.
Social Work licensure required.
Minimum of two years of experience in health care customer service or Nephrology patient care within a physician office, dialysis center, or other medical environment.
Clear and persuasive patient communication skills.
Successful problem‑solving experience.
Excellent verbal, written, and presentation skills.
Short‑task project management experience.
Familiarity with MS Word, Excel, PowerPoint, and computer user interfaces.
Organized and detail‑oriented with a strong bias for follow‑up and problem resolution.
Proven ability to be a team player.
Compensation
Rate: $XX - $XX (dependent on work location and qualifications).
Benefits
Benefit Overview: Comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave, and potential for performance‑based bonuses.
Drug‑Free Workplace
Fresenius Medical Care maintains a drug‑free workplace in accordance with applicable federal and state laws.
Equal Opportunity Employer
EOE, disability/veterans
#J-18808-Ljbffr