Overview

Are you seeking challenging healthcare role with an innovative, dynamic health organization committed to providing high quality, compassionate, accessible and affordable health care services?

The Social Worker (MSW) supports the development and monitors of the plan of treatment for a caseload of program participants, and provides community-based (in-home and telephonic) evaluation of services to ensure the health, safety, and well-being of vulnerable and high-risk populations. This includes supporting transfer coordination, discharge planning, and issuance of all appropriate authorizations for covered services as needed by members. This position provides social services support such as participant screening, case management, counseling and referral.

Essential Functions of the Job:

  • Responsible for the proactive management of acutely and chronically ill patients with the objective of improving health outcomes and costs by providing the social services support critical to delivering the participant plan of treatment that reflects an comprehensive needs assessment, intervention development, and support.
  • Conducting a comprehensive health and psychosocial assessment of participants’ medical needs, diagnosis, functional and cognitive abilities, and environmental and social needs, to determine which service(s) are required to meet participants’ needs and preferences in the community.
  • Working with the participants, their legal representatives, circles of support, and/or primary care physicians and providers to:
  • Develop goals associated with the participant’s assessed needs, individual circumstances, and preferences.
  • Mitigate risk and minimize disruptions in services.
  • Identify when services identified in the POT are available through friends, family, and/or publically funded programs.
  • Implement the POT, which includes identifying service providers and community resources to help assure the timely, effective, and efficient mobilization and allocation of the services.
  • Identify (and train, if necessary), backup caregivers who are willing and able to provide unpaid support if and when waiver service providers do not arrive when scheduled.
  • Develop resources and refer patients and families to appropriate community agencies or facilities, acts as liaison with such organizations and as advocate for participants.
  • Participates as a clinical consultant within the Homes Health Program to review and inform regarding the participants health action plan, act as clinical resource for care coordinators, as needed; and facilitate access to primary care and behavioral health providers, as needed to assist care coordinators.

Job Requirements

Education Required (Minimum level of education):

  • Minimum: Master’s Degree from an accredited School of Social Work.

Preferred:

  • Experience as a Clinical Social Worker; one year in Clinical Health care setting.

Certifications/Licenses Required:

  • CA valid driver’s license and reliable transportation and proof of current vehicle insurance (if applicable)

Preferred:

  • First Aid/CPR certification.

Experience Required:

  • 2 years of experience working in a managed care health plan or 2 years of experience in utilization review, case management, and/or discharge planning or 2 years of experience in transitional care and acute care settings (critical care, acute hospital care, long term acute care, skilled nursing care, long term care)
  • Knowledge of and/or experience with Managed Care Health plans, Medi-Cal/Medicaid, and/or Medicare.

Experience Preferred:

  • Knowledge of managed care regulations (state and federal)
  • Principles and practices of health care service delivery, managed care, health care systems, and medical administration
  • Experience performing audits analyzing productivity and quality of utilization management
  • Knowledge and/or experience with the senior care market, including competitors, regulations, and available resources

Tracking

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