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 Medicine’s 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 patient’s 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 Medicine’s 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. 

                                                       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 driver’s 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