20 Health Plan Network Development Manager Jobs Hiring Near You

Required:

1. Social Work or related undergraduate degree with active licensure as a social worker in Ohio or West Virginia upon hire. All licensed staff are expected to hold active licenses in both Ohio and West Virginia by the end of their 90-day probationary period with demonstrated compliance with licensure and Board of Social Workers continuing education policy throughout hire.
2. Relevant experience in a hospital, skilled nursing facility, outpatient unit or related setting.
3. Excellent oral, written, telephonic and interpersonal skills to balance independent and teamwork environments.
4. Demonstrated knowledge of Microsoft Office programs.
5. Flexibility, ability to multi-task and work in a fast-paced environment and adapt to changing processes.
6. Proficient keyboarding skills and computer literacy with the ability to navigate through multiple systems.

Desired:

1. In-depth knowledge and skills related to care resources, community resources, discharge planning and health care financial environments. Remains current through conferences, workshops, and professional networking.
2. Superior work ethic and commitment to excellence and accountability.
3. Ability to demonstrate independent and sound judgment in decision making, utilizes all relevant information to proactively identify and resolve issues.
4. Master of Social Work desired but not required.
5. Case Management Certification (CCM) or Certified Advanced Social Work Case Manager desired but not required.

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.
14. Prioritizes assignments appropriately and maintains flexibility as new priorities arise.
15. Participates in Grand Rounds, Transitional Care and Post Discharge Outreach.

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.