Clinical Social Worker

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 assumes 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.

REPORTS TO: SR. MANAGER, FIELD CARE MANAGEMENT

DEPARTMENT: KENTUCKY HEALTH SERVICES-STATE

POSITION LOCATION: LOUISVILLE, KY 40223



Essential Functions:

  • 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.

andidate Education:
  • Master's Degree in Social Work (MSW) is required
Candidate Experience:
  • 2 years of experience in relevant social work and/or health care experience with client care coordination responsibilities (preferably in long-term care) is required
  • Experience in a managed care environment is required

Candidate Skills:
  • Ability to work independently
  • Ability to multi-task
  • Demonstrated time management and priority setting skills
  • Demonstrated interpersonal/verbal communication skills
  • Ability to create, review and interpret treatment plans
  • Advanced ability to communicate on any level required to meet the demands of the position
Licenses and Certifications:
A license in one of the following is required:
  • Licensed Social Worker (LSW) is required
  • Licensed Mental Health Counselor (LMHC) is required
  • Licensed Professional Counselor (LPC) is required
  • Licensed Marital and Family Therapist (LMFT) is required
  • PsyD is required
Technical Skills:
  • Microsoft Outlook is required
  • Microsoft Word is required
  • Microsoft Excel is required
  • 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 is required

    About us
    Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.