West Social Operations

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Reporting to SNP Care Management Operations leadership, the SNP Social Worker will be an integral member of the health plan's medical management team. The SNP SW will assist the SNP Care Manager in the coordination of benefits with MA and Medicaid and connecting members to community resources. The SW will be an important part of the ICT in members with BH and SDOH needs. This position is committed to the constant pursuit of excellence in improving the health status of our members and community. This team member will have high organizational visibility and responsibility in ensuring overall excellence in all areas of care management.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Masters Degree in Social Work or related field.
2. Current social worker licensure for the applicable service area:
WV: Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW) or Licensed Independent Social Worker (LICSW) through the West Virginia Board of Social Work.
PA: Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists and Professional Counselors.
OH: Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Independent Social Worker-Supervision (LISW-S) through the Ohio Board of Social Work.
MD: Licensed Masters Social Worker (LMSW), Licensed Certified Social Worker (LCSW), or Licensed Certified Social Worker-Clinical (LISW-C) through the Maryland Board of Social Work.
EXPERIENCE:
1. Two (2) years of clinical experience.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. LICSW certification in the state of West Virginia.
EXPERIENCE:
1. Management of Medicare and/or Medicaid populations.
2. Two (2) years of Behavioral Health experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Participate in activities related to care management program build, implementation, oversight, and delegation.
2. Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
3. Perform psychological, social and economic care management interventions for members with severe/persistent mental or emotional disorders.
4. Perform telephonic behavioral health comprehensive assessments of members' environmental, behavioral, psychological, economic and social factors.
5. Assist in the development of individualized and culturally sensitive care plans in collaboration with the member's assigned CM, identifying problems, interventions, barriers and goals.
6. Performing telephonic re-assessments, care plan revisions and evaluating the effectiveness of the members' care plan.
7. Member of the ICT for members with SDOH and BH needs and participates in ICT meetings when appropriate.
8. Recognizes early signs of a members' decompensation that requires immediate case management intervention that promotes and motivates compliance with treatment plan.
9. Serves as an additional point of contact during transitions of care.
10. Co-manages member cases with the CM to address psycho-social, economic and cultural issues that may impact the members' care needs.
11. Serves as a primary socio-economic resource for the D-SNP Care Management Team.
12. Documents in the members' case accurately and timely to ensure coordination of the members' care needs.
13. Adheres to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC.
14. Collaborate with all members of the interdisciplinary care team to facilitate appropriate community resource assistance for members with identified needs.
15. Screens, identifies, diagnoses, treats and manages mental health and/or substance abuse problems in patients and family members.
16. Knowledge of hospital, medical center and/or health system resources to access and provide for patient care needs.
17. Maintains a working knowledge of community agencies and resources and serves as a liaison between them and the healthcare system.
18. Collaborates for appropriate resource and financial management which may include but is not limited to-financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to stand and walk short distances for eight or more hours.
2. Frequent bending, stooping, or stretching.
3. Ability to lift 30 pounds and push 50 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
2. Some travel may be required to offsite meetings.
SKILLS AND ABILITIES:
1. Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
2. Excellent written and oral communication.
3. Problem solving capabilities to drive improved efficiencies and customer satisfaction.
4. Attention to detail.
5. Proficiency with Microsoft Office products.
6. Ability to work under stressful working conditions.
7. Meeting defined deadlines and deliverables is an imperative skill for this role.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
PHH Peak Health Holdings
Cost Center:
2403 PHH Medical Management