Coordinates the socio economic needs and service of selected member populations across the continuum of illness. Interviews, coordinates and plans activities and behavioral routines to meet the social and medical needs of members and their families. May manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care. May assume a behavioral health leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Case Management to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
DEPARTMENT: Field Health Services REPORTS TO: Manager, Field Care Management
Participates in and supports developed care plans for members with high level acuity needs utilizing social service expertise to evaluate the members need for alternative services and third party needs.
Outreaches to members telephonically and/or in-person and coordinates member's case management services.
Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address/support medical needs. Reviews benefits options, researches community resources, coordinates services, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
Provides telephone follow-up to ensure members have seen their PCP and are completing their treatment plan or preventive care services a defined by the PCP or guidelines.
Coordinates community resources with emphasis on the development of natural support system. Coordinates benefits, regulations, laws and public entitlement programs.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
May manage members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Acts as team SME in order to achieve optimal clinical and resource outcomes.
Performs other duties as assigned.
Required a Master's Degree in Social Work (MSW)
Required 2-4 years relevant social work and/or health care experience with client care coordination responsibilities (preferably in long-term care).
Preferred experience in a managed care environment.
Licenses/Certifications: Licensure in one of the following is required:
LSW, LCSW, LMHC, LPC, LMFT, PsyD
Special Skills (e.g. 2nd language):
Ability to work independently, handle multiple assignments and prioritize workload
Communicates effectively in person and by phone
Advanced ability to communicate on any level required to meet the demands of the position
Ability to create, review and interpret treatment plans
Proficient in Microsoft Office including Outlook, Word and Excel.
Knowledge of or the ability to learn company approved software such as EMMA, CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties.