Social Worker

The Social Worker is responsible for the navigation and advocacy of identified members stratified relevant to their practice. These members require coordinated care and integration into multiple health and social systems. This may include providing the member with information and assistance to access a wide spectrum of services directed at social, medical/behavioral and lifestyle interventions to promote health and wellness and support individualized goal attainment through care planning and self- management.

Required

Desired

Responsibilities

• 1.
• Social Workers are responsible for reporting any changes in licensure (e.g., application declined/denied; license revoked/suspended or lapsed; notification of an investigation by licensing board; becoming subject to disciplinary action by a licensing board) to their direct supervisor through their term of employment.
• 2.
• Identifies members at risk for psychosocial needs related to health care status through direct communication with hospital social workers and discharge planners, network practitioners, The Health Plan staff, and The Health Plan members or supportive others.
• 3.
• Completes contacts via telephone calls, as appropriate, to follow-up on referrals received, assesses for psychosocial needs and provides concrete or supportive interventions.
• 4.
• Assists The Health Plan members and/or their supportive others, The Health Plan staff, or practitioners in making community resource referrals.
• Also provides appropriate follow-up regarding the outcome of a referral.
• 5.
• Performs research to identify appropriate community resources and maintains information of available resources to meet various member needs.
• 6.
• Completes accurate and timely documentation of contacts, needs assessments, interventions and outcomes in Case Tracker.
• Researches and obtains member information.
• 7.
• Collaborates with Health Plan staff in providing practitioner and facility education regarding available support services to assist members with complex care needs.
• 8.
• Works with The Health Plan staff to develop and implement programming for social intervention consistent with identified needs of specific member populations i.e.
• Medicare and Medicaid.
• 9.
• Maintains a level of competency to deal with chronic disease navigation and health maintenance issues by attendance at regularly scheduled health education meetings.
• 10.
• Strives to improve quality in all areas of responsibility and cooperate with all departments to improve quality throughout The Health Plan.
• 11.
• Serves as assigned on departmental or company committees.
• 12.
• Promotes communication, both internally and externally, to enhance effectiveness of medical management services.
• 13.
• Identifies opportunities for improvement in systems, processes, functions, programs, procedures and makes recommendations to the Assistant Director, Medical Management.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

8:00am - 5:00pm 40