Job Description

Job Description

Job Description

Distinctive Home & Health Care is a leading provider of healthcare to serve military installations across the United States. Our team of professionals is dedicated to providing the highest quality of service and support for each one of our clients. Distinctive Healthcare is currently seeking to hire a full time LCSW Special Needs Coordinator at Minot AFB in Ward County, North Dakota

The Special Needs Coordinator (SNC) oversees and manages the Exceptional Family Member Program Medical (EFMP-M) IAW DOD and Air Force (AF) policy, and any subsequent implementing guidance. Establishes and maintains procedures to identify family members with special medical and educational needs in a timely manner. The SNC uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouse’s groups, to ensure effective outreach and identification of special needs. 

Must have knowledge and skills to effectively apply SNC functions: a) Assessment: Identification of patients that need special medical and education needs/management; comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care; b) Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care; c) Facilitation: Care coordination and communication among all involved parties; d) Advocacy: Support for the patient and family/caregivers to ensure identified education and appropriate, timely care coordination is received.

Mastery of theories, principles, and methodologies underlying psychosocial practice

Knowledge and understanding of developmental growth; dynamics of human behavior, family, and other social systems; and impact of illness and disability on social functioning.

Demonstrated abilities in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments.

Strong capability to work with service members and/or veterans and their families who are experiencing a wide range of complicated mental, emotional, behavioral, physical, psychosocial, and environmental problems.

Working knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC).

Working knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet familiarity is required.

Must demonstrate ability to communicate effectively both orally and written.

Must be skillful and tactful in communicating with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and potentially agitated.

Must demonstrate ability to apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal, and financial patient situations.

Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.

• Degree/Education: Master’s degree in Social Work (MSW). Graduate from a school of Social Work fully accredited by the Council on Social Work Education (CSWE).

• Experience. A minimum of two years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four years.

• Licensure/Registration: Current, full active, and unrestricted license to practice as an LCSW

HCW Duties:

• The SNC social worker oversees and manages the installation EFMP-M IAW DoD and AF policy and any subsequent implementing guidance.

• Uses clinical assessment skills and maintains procedures to identify sponsors whose family members have special medical and educational needs in a timely manner. The SNC uses a multi-disciplinary and collaborative approach with other key service providers, such as installation youth and childcare facilities, and officer and enlisted spouse’s groups, to ensure effective outreach and identification of special needs. Ensures family members of the AF personnel or family of the AF member are appropriately “Q coded” (EFMP-enrolled).

• Ensures all active duty sponsors known to the Air Force Personnel Center, and local Military Personnel Section (MPS) and/or Commander Support Staff (CSS) where applicable, having family members with special needs are identified in AF medical special needs data management systems. Provides oversight for base- level data entry in AF-provided data management systems used in the management of EFMP-M.

• Provides training to installation personnel and medical staff; and consultation as needed to support the implementation of EFMP-M base-wide.

• Integrally involved in the Family Member Relocation Clearance (FMRC) process. Ensures all FMRC requirements are implemented by all EFMP-M staff. Coordinates the enrollment process and travel screening for all active duty family members’ and travel screening upon request to the families of DoD civilian sponsored assignments going to an overseas base.

• Provides oversight to ensure every AF sponsor with one or more family members with special needs assigned to the installation has a SN file maintained at the Medical Treatment Facility (MTF). Ensures Q-coded sponsors assigned to the installation are contacted annually to determine if there are unmet needs and to request updates of information as needed.

• Collaborates with the Integrated Delivery System (IDS) and other interagency forums that provide family medical information and referrals to base and civilian agencies. Ensures EFMP families are referred to the Airman and Family Readiness Center for additional community assistance as needed. Maintains a cooperative working relationship with the base MPS, CSS, and with Air Force Personnel Center (AFPC). Actively supports the integration of EFMP-M, Exceptional Family Member Program – Family Support (EFMP-FS) and Exceptional Family Member Program – Assignments (EFMP-A) services at the installation. Provides information, appropriate contact information, and coordinates referrals as appropriate.

• Participates in EFMP quarterly case reviews to discuss/assess newly identified families’, complex, or unmet medical needs. Determine the appropriate resources necessary for the families.

• Patient specific assessments and clinical plans of action will be located in AHLTA and the Special Needs record. Meeting minutes will not contain patient identifying information.

• Coordinates and participates in designated facility meetings.

• Participates in the clinic orientation and training of other staff of the Special Needs Program. May serve on committees, work groups, and task forces at the facility.

• Must maintain a level of productivity and quality consistent with complexity of the assignment; facility policies and guidelines; established principles, ethics, and standards of practice of professional social work, Health Services Inspection (HSI); and other applicable DoD and service specific guidance’s and policies. Must also comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.

• Follows applicable local MTF/AF/DoD instructions, policies, and guidelines.

• Completes medical record documentation and coding and designated tracking logs and data reporting as required by local MTF/AF/DoD instructions, policies, and guidance.

• Completes all required electronic medical record training, MTF-specific orientation and SNC training programs

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