Master Social Worker Care Manager
Current
3575 Geary Blov. Sf, Ca
Conducts comprehensive psycho-social assessment, identifying important health (mental and physical), psycho-social, environmental and spiritual problems of the client and existent support systems. Determines client’s functional level based on findings from the social work assessment. Writes social work assessments, consistent with the guidelines in the MSSP manual, which are client-centered, comprehensive, timely and legible. Identifies appropriate community services with a good knowledge of Medicare, Medi-Cal, and other entitlement programs. Makes quarterly home visits and contacts clients monthly and reviews the service plan. provides supportive, emphatic, and consistent counseling and teaching; sets limits and maintains professional distance; confronts the important problems and follows through with therapeutic interventions in a timely manner. Provides crisis intervention and advocacy when necessary. Identifying and documenting changes in client’s mental, physical, psycho-social, and spiritual status. Monitors the quantity and quality of the services provided, especially the primary care provider and/ or homemaker who provides the personal care. Also monitors the other service providers involved. Completes scheduled reassessments for each client, reviews and documents change(s) in client’s psycho-social status when completing the reassessment form every year according to site policy. Determines the functional level of each client every year for clients of his/her respective team. Continuously evaluates the need of the team’s clients for case management to remain safely at home, and places the client or closes cases when appropriate according to MSSP guidelines. Terminates clients when appropriate by discussing the reasons why the termination is appropriate with the client, caregiver, and services involved. Documents this process in the progress notes and turns in the termination form to his/her supervisor.