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.
DEPARTMENT: Health Services
REPORTS TO: Supervisor, Field Health Services
- 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 achive optimal clinical and resource outcomes.
- Performs other duties as assigned.
- A Master's Degree in Social Work (MSW).
- 2-4 years relevant social work and/or health care experience with client care coordination responsibilities, (preferably in long-term care).
- Experience in a managed care environment required.
- A license in one of the following is required: LSW, LCSW, LMHC, LPC, LMFT, PsyD
- Intermediate - Ability to work independently.
•Intermediate - Ability to handle multiple assignments and prioritize workload.
•Intermediate - Demonstrated interpersonal/verbal communication skills. Intermediate - Ability to communicate effectively in person and by phone.
•Intermediate - Ability to create, review and interpret treatment plans.
•Intermediate - Ability to multi-task.
•Intermediate - Ability to work within tight timeframes and meet strict deadlines.
•Intermediate - Ability to effectively present information and respond to questions from families, members, and providers.
•Intermediate - Ability to effectively present information and respond to questions from peers and management.
•Intermediate - Demonstrated problem solving skills.
•Intermediate - Demonstrated written communication skills.
•Intermediate - Demonstrated time management and priority setting skills.
•Intermediate - Knowledge of healthcare delivery.
•Intermediate - Knowledge of community, state and federal laws and resources.
- Proficient in Microsoft Outlook, Word and Excel.
- Knowledge of, or the ability to learn company healthcare management systems in order to perform job duties required.
- Bilingual language proficiency is a plus.