Job Description:

Job Essentials

Identifies patient populations using specific screening criteria including psychosocial screen, medical record review or through referrals for service per department policy/guidelines includes trigger list, timeframes for assessing patient, and pre-screen criteria. Review of medical records, focused reports and/or referral information to gather relevant data per department guidelines. Obtains additional necessary information by interviewing the patient/family/significant other (SO). Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Ensures a plan of care is developed and maintained for members receiving care management services consistent with COP/NCQA and department standards.

Coordinates and facilitates communication among the member/caregivers /representative, members of the healthcare team, and other relevant parties (e.g. referral physicians, community organizations, post-acute providers, other payers, Sales Team, Employer Groups, etc.). Coordinates with appropriate individuals to help ensure consults, testing, procedures are sequenced in a manner that is appropriate to patient clinical condition and supports timely and efficient care delivery. Care Management will actively intervene and resolve/escalate where barriers to service exist across the care continuum. Maintains a current knowledge of community resources. Where necessary performs cost benefit analysis and coordinates authorizations for appropriate level of care. May diagnosis various mental, emotional and behavioral disorders using DSM 5 guidelines. Provides supportive, crisis and other social work interventions as identified. Coordinates and collaborates with external agencies including DCSF, APS, and law enforcement when abuse, neglect or exploitation is suspected or confirmed. May provide therapeutic modalities appropriate to the level of care. Acts within the scope of the Mental Health Practice Act.

Minimum Qualifications

• Master's Degree in Social Work. Education must be obtained from an accredited institution. Degree will be verified.
• Current State Licensure as a Licensed Clinical Social Worker (LCSW).
• Basic computer skills and knowledge of word processing and spreadsheet software.
• Strong written and verbal communication skills.
• Demonstrated ability to exercise critical thinking skills.
  

Preferred Qualifications

• Case Management Certification.
• Experience working in clinical care management, social work or with third party payers.
• Knowledge of care management.
• Knowledge of health insurance related products.
• Working understanding of coding, episode of care and length of stay guidelines.
• Written and verbal communication skills.
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.

Physical Requirements:

Interact with others requiring the employee to communicate information.
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Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Work City:

Work State:

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package and our commitment to diversity, equity, and inclusion .