Job Description:

Business Unit: Health Care Quality & Affordability

The Health Care Quality and Affordability team is made up of about 1,000 doctors, nurses, pharmacists, strategists, industry experts and innovators with a single vision - to transform the delivery of health care. Every day, we work together to improve the quality of patient care for our members while lowering health Care costs to ensure all Californians have access to the care they deserve.

How do we do it? Through partnership, innovation, and thought leadership.

We continue to expand our network of providers to ensure state-wide access to care. We evaluate analytic and digital health tools that simplify care delivery while improving member health status, health care quality and affordability as well as member and provider experience. We provide high-touch services to members from experienced clinical teams. You'll also find us collaborating with our federal and state legislative officials to help shape policy to advance our Blue Shield mission.

Position Summary:

The care management social worker will report to the senior manager of care management and will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The selected candidate is responsible for the development, planning, implementation, and evaluation of all social service-related interventions for the Case Management Department. Specifically, this position will be responsible for identifying patients who have psycho-social needs. The Ambulatory Case Manager/Social Worker is also available to physicians and nurse case managers as a consultant for those patients with complex psychosocial needs. The position demands for an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, biopsychosocial assessments, education, advocacy, and community resource linkages. The care management social worker will provide support to individuals including, but are not limited to, high risk and frail patients, seniors, and those with chronic and terminal medical conditions.

The selected candidate will also function as the subject matter expert on social services, represent care management in initiatives, act as a liaison between other business units within Blue Shield to bolster care management social work knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management. The care management social worker applies detailed knowledge of Blue Shield of California (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. CM care typically lasts three months per member/patient; reinforce pillars of care, that include but not limited to increasing quality of patient care and access while improving member satisfaction. The care management social worker must have extensive background of the care management operations and a solid knowledge of community resources, best practices, and the promotion holistic and integrated high-tech and high-touch approach to medical care management.

Specific Responsibilities Include:

- Evaluates and implements a high-tech, high- touch intervention for patients with psycho/social issues. With focus on seniors, catastrophic and chronic patients. Specifically:

- Utilization of depression Screening tools for selected populations

- Develops reports for outcome measurement

- Implementation: triage patients with the case management team; assist in coordination of patient care delivery, including DPA; document pertinent information in the case management system and communicate to team.

- Evaluation: evaluate caseload daily and assess achievement of long- and short-term goals; modify goals with providers and case management based upon patient outcomes; compile and present statistics and reports relating to patient outcomes; document findings in the patients chart or case management system

- Communication: provide follow up and outcome communication to the referral source, i.e. PCP, family member, case manager, home health personnel, community social worker, Health Plan, ect.

- Act as social services liaison for the department and physician offices, particularly in the areas of:

- Complex discharge planning

- Referral to agencies which provide supportive services to fragile patients

- Assists in arrangement of community resources (i.e. meals on wheels, transportation services, adult day care, and info-line)

- Assists in long term planning for patients transitioning to an institutionalized setting

- Provides alternatives for patients requiring specific services while lacking insurance coverage

- Acts as liaison to Population Health department regarding chronic disease state management programs

- Facilitates as liaison to the Member Services and QI departments to address any ongoing case management issues or concerns as referred.

Specialty Areas:

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Strong clinical documentation skills, independent problem identification and resolution skills.

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Strong verbal and written communication and negotiation skills.

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Works on projects with minimal supervision.

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Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context.

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Member Advocacy: Advocates understanding and respect for the beliefs, value system, and decisions of the client. Recognizes the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family right to make informed choices that may not promote the best outcomes, as determined by the healthcare team.

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Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context.

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Assists with precepting responsibilities for new hires and auditing efforts

Minimum Education & Experience Requirements:

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A minimum of a master's degree in social work or social welfare) from a regionally accredited college or university.

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A minimum of 3 years' experience in inpatient, outpatient or managed care environment.

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A minimum of 5 years' combined experience in clinical social work practice in the hospital, outpatient or managed care setting.

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Licensure as Clinical Social Worker (LCSW) in California

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Certified Case Manager (CCM) or related board certification from a nationally recognized entity, i.e. ACM, Palliative Care

Knowledge and Skills:

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Health insurance/managed care experience (Commercial, Medicare, and Medi-Cal)

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Lean methodology

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Excellent presentation and procedure-writing skills

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Excellent communication skills

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Transitions of care

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Community resources and advocacy

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Practice integration in a triad model of care

Additional Information

- Our Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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