Care Manager, Non-Medical Drivers of Health, Food Market (4662)

Key Responsibilities:

- Deliver relevant case management and resource navigation services for high-risk children and/or pregnant women referred to WFM's patient-choice food rx program

- Assists in providing a clean, safe, efficient and welcoming environment in Waco Family Medicines food pantry and its facility

- Assists with the receiving of food items, stocking of food items, and organization of the pantry space as needed.

- Conduct required patient/neighbor intake and data entry

- Collaborate with internal teams on continuous improvement efforts for the patient-choice food rx program and CPW service line

- Assist with the provision of Nutrition Education training to patient/neighbors

- Assess and respond to psychosocial, financial, NMDOH, functional, cognitive and medical needs.

- Identify and address gaps in patient care through visits to the Food Market; Identify and utilize patients systems of support and facilitators for reaching health goals.

- Conduct comprehensive psychosocial needs assessments, screen and refer to appropriate agencies or internal programs for NMDOH needs.

- Develop individualized care plans for eligible care management patients focusing on short and long-term medical, behavioral health, and NMDOH goals of care.

- Assist patients in navigating the healthcare system and Waco Family Medicines food pantry.

- Apply knowledge of community resources to address care gaps or improve quality of life conditions.

- Full-time, 40 hours per week with a work schedule of Monday – Thursday with evening hours, and scheduled Saturdays.

OTHER DUTIES

- As assigned by supervisors.

Qualifications

Care Manager, Non-Medical Drivers of Health, Food Market

REPORTS TO: Director of Non-Medical Drivers of Health Programs & Program Manager for Non Medical Drivers of Health Programs

EDUCATION & EXPRIENCE : Master's Degree in Social Work required; Active Texas Licensed Master Social Worker required; Experience in social services, counseling, or case management preferred; Experience providing social services in healthcare settings preferred; Fluency in English and Spanish is highly preferred to support effective engagement with Spanish-speaking patients, community members, partners, and stakeholders to advance equitable access to services.

SKILLS: Knowledge of health care conditions and needs of children and pregnant women; Knowledge of non-medical factors that influence access to care and health outcomes of children and pregnant women; Ability to learn and apply case management and patient education skills; Strong interpersonal skills with the ability to build effective relationships across interdisciplinary care teams and with patients; Proficiency in problem identification and care plan development; Professional interaction skills with medical providers and other healthcare professionals; Skillfully conduct psychosocial and non-medical drivers of health (NMDOH) assessments and screenings; Ability to learn and apply evidence-based behavioral strategies and interventions for NMDOH; Strong written and oral communication skills.

PHYSICAL AND MENTAL REQUIREMENTS

- Possess a valid Texas drivers license and appropriate liability insurance

- Access to personal transportation

- Visual and auditory accuracy

- Shift length varies

- Indoor setting

- Continuous use of computer

- Long periods of sitting

- Frequent use of telephone and/or smart devices

- Continuous repetitive grasping and manipulation of both hands

- Continuous conversational communication

- Occasional reaching, walking, squatting, bending, kneeling, twisting and climbing

- Frequently carrying, lifting, pushing and pulling of up to 50 lbs.

- Occasionally working in confined, noisy, dusty areas

- Understand/carry out simple/detailed, oral/written instructions

- Memorize and retain instructions

- Read and interpret detailed specifications

- Mental competency

- Tobacco non-user

- Physical accommodations will be implemented where necessary and feasible