Licensed Social Worker, Care Management Salinas

Description

The Social Worker will work on a multidisciplinary healthcare team in a primary in person / telephonic setting; focusing on coaching and coordination of care for patients needing navigation and addressing patient care needs and follow up after clinical care. Responsibilities specific to Social Worker include providing observation ongoing assessment and therapeutic intervention consistent with physical and psychological status. Awareness of services available to patients and their families is an important part of this assessment

FLSA Status

Exempt

Salary Range

$79200 -$110000

Reports To

Director Medical Management

Direct Reports

Yes

Location

Salinas CA

Travel

Up to 75%

Work Type

Regular

Schedule

Full Time

Duties and Responsibilities

• Assess identified members to determine appropriate members for management early in their disease process and at any time during the continuum of care.
• Complete a comprehensive assessment to identify patient risk and develop a care plan utilizing expertise and judgement to evaluate needs for alternative services as needed.
• Assess members Social Determinants of Health such as housing food transportation and safety in the home.
• Work collaboratively with physicians and community resources including pharmacists nurses registered dieticians and other disciplines to address patient needs as identified in assessments.
• Assess and screen members for behavioral health concerns (depression / substance abuse) utilizing screening tools including the PHQ2 and 9 Depression screenings and ensure they are receiving appropriate behavioral health interventions.
• Facilitate any necessary follow-up or referrals for behavioral health needs with local behavioral health providers.
• Develop facilitate and communicate a plan of care in partnership with the member family (or designated representatives) providers and multidisciplinary care team to assess the options of care including use of benefits and community resources.
• Update care plan to include progress towards achieving established goals and self-management activities.
• Coordinate necessary referrals and authorizations pertinent to patient care and well-being.
• Utilize developed systems processes and initiatives to engage patients in relevant social activities necessary to promote wellness and care at the right place and time.
• Facilitate member adoption of strategies to promote physician recommended behavior changes.
• Identify and utilize cultural and community resources and align with the patients cultural preferences as much as possible.
• Facilitate the information flow between health representatives and the care team.
• Coordinate care and communicate with multiple providers internal and external to the practice.
• Act as a resource for both clinical and non-clinical staff i.e. care coordinators dieticians RN Case Managers.
• Attend required training and collaboration sessions i.e. learning sessions / practice team meetings as scheduled.
• Provide and facilitate open communication regarding patient status with physicians and patient care team.
• Dev elop constructive relationships with internal GLIN population health team members participating providers and community resources.
• Other job-related duties as assigned.

Working knowledge of the following required :

Examples of Competencies :

Physical / Mental Demands and Work Environment

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Examples of Work Environment

While performing the duties of this job the employee is regularly required to walk bend sit talk lift or hear. The employee is regularly required to stand walk and use hands and arms to operate general office equipment PC telephone file cabinets copier postage meter fax machine and printer. The employee may occasionally lift and / or move between 10 and 25 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus. The employee may need to travel to healthcare practices.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually low to moderate.

The Company reserves the right to modify the job description based upon its needs and may require the employee to perform functions beyond those mentioned above. Neither this job description nor any other communication creates an employment contract between the Company and the employee.

Qualifications or Education Training and Experience

Benefits :

As a firm passionate about health care were deeply committed to the health and wellness of our own team members. We offer comprehensive affordable insurance plans for our team and their families and a host of other unique benefits such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here : COPE Health Solutions

COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise experience proven tools and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers health plans and self-insured employers. For more information visit .

To Apply : Key Skills

Motivational Interviewing,Acute Care,Crisis Intervention,Behavioral Health,Intake Experience,Hospice Care,Case Management,Home Care,Child Welfare,Experience with Children,Social Work,Addiction Counseling

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 79200 - 110000