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 medical, social and emotional needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care. Collaborates with the interdisciplinary team to achieve optimal resource outcomes. Works with Case Management to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
Reports To: Mgr, ACO, Clinical
Department: Health Services
Position Location: Houston, TX 77081
Additional Responsibilities:Candidate Education:
- Participates in and supports developed care plans for members 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.
- Performs other duties as assigned.
- Required A Bachelor's Degree in Social Work (BSW), Psychology, Counseling, Rehabilitation, or other relevant field
- Required 2 years of experience in social work experience
- Required Other Experience in a managed care environment
Licenses and Certifications:
- Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
- Intermediate Demonstrated interpersonal/verbal communication skills Communicates effectively in person and by phone
- Intermediate Ability to create, review and interpret treatment plans 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
A license in one of the following is required:
- Required Intermediate Microsoft Outlook Proficient in Microsoft Office including Outlook, Word and Excel
- Required Intermediate Microsoft Word 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
- Required Intermediate Microsoft Excel
- Required Intermediate Other 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.