SOCIAL WORKER
Coventry Health Care's Medicaid Division is currently seeking a Social Worker for our enhanced case management program that focuses on high risk co-morbid Medicaid ABD members. The ideal candidate will have experience working with the senior population. The Social Worker position will perform home visit to members in and around the Richmond area.
ESSENTIAL RESPONSIBILITIES
- Performs initial and periodic assessments of the members enrolled in the Co Morbid Case management program. Case management activities will focus on quality of care; compliance; outcomes and decreasing costs.
- Directs social work interventions including performing psychosocial assessment(s); telephone follow-up and facility assessments as indicated; documentation of problems; assessments; and/or interventions; and promoting ease of access to a continuum of care through appropriate information and referral.
- Proactive management with the objective of improving quality outcomes and decreasing costs.
- Applies case management concepts; principles and strategies in the development of an individualized case plan for enrolled members in case management that are at risk of poor outcomes. The case plan process includes assessment; goal setting; establishing interventions related to goals; monitoring success of the interventions; evaluating the success of the overall case plan and reporting outcomes and addresses the member?s broad spectrum of needs.
- Conducts regular discussions as part of a multidisciplinary team and communicates updates with providers; the primary care physicians; health plan Medical Directors; pharmacists; and health services staff regarding the status of particular patients.
- Serves as a member advocate to ensure the member receives all of the necessary care allowed under the member?s benefit plan.
- Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits.
- Utilizes community resource expertise and alternate funding arrangements available to plan members when services are not available under the benefits program.
- Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay; and preventing avoidable Emergency Department utilization.
- Develops relationships with hospital social workers and community resources to assure appropriate case management of catastrophic; acute; and chronically ill members.
- Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the Quality Improvement Department.
- Indirect services will include meeting federal; state; and NCQA/URAC regulations to assure quality service; working cooperatively with and training other members of the UM team; providing social work consultation to healthcare professionals and members; maintaining an information base of referrals; submitting reports of services provided as directed by department policy; functioning as a liaison person with appropriate community agencies; and determining and implementing policies and procedures with respect to the delivery of social service functions.
- Maintains confidentiality of member information in accordance with HIPPA. Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree in Social Work, Psychology or Gerontology required. Master’s degree preferred. LSW preferred.
- Complies with all state requirements in the state where job duties are performed.
- Minimum (2 years) experience in medical social work or case management. Thorough knowledge of casework and group work principles, practices, and methodology. Extensive knowledge of community resources.
- Considerable knowledge of individual and group behavior and inter-relationships among social, economic, psychological, and physical factors. Considerable knowledge of the regulations, standards, and policies which relate to social work practice.
- Regular local travel required.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Richmond, VA, US
Organization: 10900 - CMS - STAR Corporate
Schedule: Full-time
Job Posting: 2013-02-06 00:00:00.0
Job ID: 1310439