Clinical Team Supervisor Access Health
The Clinical Supervisor will be responsible for providing direct supervisory oversight and clinical leadership for the continuity of care/post-discharge care coordination services for individuals with multiple hospital re-admissions via HCAM’s Access Health Program with LifeBridge Health System. The Clinical Supervisor is responsible for supporting all aspects of the clients’ health, social and environmental needs through consultation and interaction with hospital care management and discharge planning teams as well as local, state and community agencies.
While this position is imbedded within Northwest Hospital, work is performed in hospitals across the LifeBridge Health System, in community-based settings (i.e., long term care facilities, provider offices), or in the client’s home and requires travel in the performance of patient engagement during non-traditional work hours.
In collaboration with the Clinical Director of Population Health and Director of Performance Improvement, the Clinical Supervisor will participate in quality improvement and interagency control activities, which may include, but not limited to, recognizing and reporting trends, collecting and participating in the interpretation of data, chart reviews, and the development of corrective action plans to improve program efficiency and maintain program integrity.
Primary Responsibilities include:
• Acquire and maintain a small caseload of clients enrolled in the Access Health program with multiple co-morbidities and/or at high-risk for re-admission/frequent emergency room utilization;
- Participate in regularly scheduled clinical supervision of Access Health team LGSW’s according to the Maryland Board of Social Work discipline regulations, as needed;
- Provide administrative supervision of Access Health staff assigned to the program at Northwest and Sinai Hospitals. This supervision includes training, coaching and evaluation of Access Health staff;
- Develop a plan of care in support of goals and patient-specific interventions that facilitate a reduction in emergency room/inpatient utilizations;
• Work in collaboration with the clinical team (i.e., social workers, registered nurses and physicians) to implement and make needed modifications to the client plan of care;
• Collaborate with internal HCAM resources and community agencies on case referrals, reporting, and supporting client needs associated with the Access Health program;
• Regularly evaluate the effectiveness of the plan of care based on the continuing documentation of the patient’s progress toward the established goals;
- Complete home visits, as necessary, to assess the patient’s health needs and ongoing progress toward mutually established care plan goals;
- Participate in staff, community, professional and inter-agency meeting and conferences;
• Provide resources and education to patients and caregivers to maintain and support wellness;
- Make referrals to the clinic specialty mental health or other community mental health or substance abuse agencies as needed;
- Provide performance improvement reviews of documentation to ensure compliance and proactively address any client issues as they pertain to the Access Health program;
- Other duties as assigned.
- Current, active, unrestricted and non-probationary LCSW-C licensure status with the Maryland Board of Social Work with at least one year of experience in clinical supervision;
- Current BLS/CPR certification
- A car and a valid driver’s license, with verifiable good driving record and reliable transportation
- Knowledge of social work and case management within an inpatient hospital setting. Knowledge of the management of chronic diseases such as asthma, COPD, hypertension, HIV/AIDS and diabetes is a plus.
- Authoritative knowledge and understanding of the principles and regulations of Maryland Medicaid and Medicare, with application of same to various social, home care, extended care and community services (Note: Completion of CAC certification is required within 6 months of employment);
- Ability to write reports and business correspondence, with exceptional written and oral communication skills to interface with patients, other health care workers/providers and community, local and state agencies
• Proficiency in the usage of word processing, spreadsheets, email, internet, electronic patient medical data systems and web-based health information databases
• Strong organizational skills and the ability to perform tasks independently
- Sound judgment, decision making and problem solving skills
• English proficiency in reading, writing and speaking to (1) interact with patient, (2) document the patients’ medical conditions in a standardized way, and (3) interact effectively with the staff at the hospital and other community agencies.