Social Worker - Case Management

Summary:

Provide varied social work (SW) services to managed care patients and their families.  Aid in development of treatment plans, patient discharge needs, and provide social, emotional and mental assessments on patients.  Act as an advocate for members and their families linking them to educational resource and community resources to support their healthcare.   SW participates in GMG High Risk meeting or Case Management (CM) team meeting to optimize care plane, treatment plans and GMG protocols.    Serves as a resource to the care team.

Essential Functions:

1. Serve as a strong resource to GMG physicians, clinical staff and CM staff regarding community services, resources, and facilities to best serve the patients.    
2. Demonstrate knowledge of utilization management, care coordination, and current standards of care as a foundation for assessment and planning activities.
3. Assess the medical, physical, psycho-social and transition needs of patients and families in various settings (hospital, SNF, home, clinic, etc.) to create individualized transitional and social plans.  
4. Conduct periodic reassessments and adjust plans accordingly.
5. Communicate effectively with patients and families to optimize the plan of care, increase customer satisfaction and minimize misunderstandings. 
6. Confer with physician(s), case manager, and other pertinent sources to gather and provide information to the care team. 
7. Communicate with the MC Medical Director as indicated on pertinent patients to discuss patient status, issues, questions.
8. Document pertinent patient/family communications, referral authorizations and plans into the EMR in a timely manner.
9. Document appropriately in complex care database and other associated work-related systems.
10. Maintain current knowledge of health plan benefits, health plan contracts and preferred provider network.
11. Assume responsibility for personal and professional development and maintenance of skills in social work
12. Exercise tact and courtesy when dealing with patients, visitors, physicians and co-workers.
13. Demonstrate effective decision-making and individual reasoning to the solution of problems.
14. Attend and participate in assigned meetings.
15. Maintains strictest member and company confidentiality; Ensures member health information is secured each day.
16. Able to work efficiently under pressure.
17. Perform other duties as assigned.

Computer Skills:

Strong computer skills required; Experience with Electronic Medical Records (EMR) Basic knowledge of MS Word, Excel, Outlook, and Internet software

Supervisory Responsibilities:

This job has no supervisory responsibilities

Education, Job Experience, and Skills:

1. Must have degree in social work (BSW) from an accredited program.
2. Two or more years of managed care experience preferred.
3. At least 3 years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions in adult and geriatric populations.
4. Able to communicate clearly in both written and verbal format. Strong interpersonal skills.

PREFERRED Language SKILLS:

Bilingual (English/Spanish) language proficiency required.

Work Environment: 

Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment, Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinic, hospital, skilled nursing facility, or patient home environment. Faced paced setting, with the ability to work nights, weekends and holidays as required; May take after hours phone calls
 

Physical Requirements:

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. Close vision and ability to adjust focus.

The above job description is not intended to be an all-inclusive list of duties and standards of the position.  Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.  Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.