Summary of Position Achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness, members who are frail elderly and/or members whose illness is complicated by challenging psychosocial conditions. Provide global, episodic, specialized or complex care management and utilization management as needed to ensure coordination of health care delivery, member education, and preventative intervention. Coordinate care in a variety of settings and provides focus on transition activities to benefit clinical needs of members while performing the care management process. Assist in managing members with behavioral health, substance abuse, and/or psychosocial conditions/issues, consulting with colleagues across the enterprise. on behavioral health, substance abuse, and/or psychosocial issues. Facilitate member adoption of strategies to promote physician recommended behavior changes. Help members improve health outcomes and provide feedback to members of the medical and care management care teams. Principal Accountabilities

• Develop, facilitate, and communicate a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various providers.
• Provide care management through assessment, planning, implementation, coordination, monitoring, and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs.
• Assist members with the coordination of services from various settings as appropriate. Include facilitating discharge from acute setting to home and acute setting to alternate settings. Provide Care Coordination throughout the continuum of care by including the member, member’s family and providers in the process.
• Assess identified members to determine members appropriate for management early in their disease process at any time during the continuum of care.
• Assess members’ Social Determinants of Health, such as housing, food, transportation, and safety in the home; assess members’ mental health needs including PHQ2 and 9 Depression screening.
• Provide mental health counseling referrals and provide appropriate support as needed.
• Optimize the quality of care and of life for the member. Identify members appropriate for specialty programs.

Qualifications

• Bachelor’s degree
• Masters’ in social work (LMSW) required
• Certification in clinical social work (LCSW) preferred
• 4 – 6+ years’ case management and/or managed care experience
• Knowledge of Federal and State regulations for Medicare and Medicaid and other national and state funded programs
• Knowledge of community resources access
• Proven track record in leading care management team(s)
• Health plan experience
• Strong problem-solving skills
• Detailed oriented and organized
• Excellent communication skills (verbal, written, presentation, interpersonal)
• Proficient with MS Office (Word, Excel, Powerpoint, Teams, Outlook, etc.)

Additional Information

• Requisition ID: 1000003209
• Hiring Range: $68,040-$118,800