Medical Social Worker (MLTC)

Job Title: Social Worker Care Manager (LMSW/MSW)

Location: Remote but must be local to NYC as you may be asked to report ~6 a year in office

Schedule/Shift: Monday-Friday, 8:30a-5p

Pay: 70-78k

3-5 Must Have Skills/Qualifications

• MLTC Care Management
• Insurance Case Management
• Medicaid
• Must be comfortable managing a caseload of 200-250 members (monthly)

Job Description Summary

Provides care management through a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet member's health needs through communication and available resources, while promoting quality cost-effective outcomes. Maintains members in the most independent living situation possible; ensures consistent care along entire health care continuum by assessing and closely monitoring members' needs and status. Provides care management services and authorizes/ coordinates services within a capitated managed care system. Closely communicates and collaborates with primary care practitioners, interdisciplinary team and family members. Works under general supervision.

Job Description

• Assesses, plans and provides intensive and continuous care management across acute, home, and long-term care settings. Develops and negotiates care plans with members, families and physicians.
• Assesses a person's living condition/situation, cultural influences, and functioning to identify the individual's needs; develops a comprehensive care plan that addresses those needs.
• Assesses an enrollee's eligibility for Program services based on his or her health, medical, financial, legal and psychosocial status, initially and on an ongoing basis.
• Plans specific objectives, goals and actions designed to meet the member's needs as identified in the assessment process that are action-oriented, time-specific and cost effective.
• Implements specific care management activities and or interventions that lead to accomplishing the goals set forth in the plan of care.
• Coordinates, facilitates and arranges for long term care services in the home and community-based sites, such as adult day care, nursing homes, rehab facilities, etc. Arranges for on-going nursing care, service authorization and periodic assessment.
• Collaborates and negotiates with interdisciplinary teams, health care providers, family members, and third party payors, as applicable, across all health settings to ensure optimum delivery and coordination of services to members.
• Monitors care management activities, services, and members' responses to interventions, to determine the effectiveness of the plan of care and the utilization of services.
• Evaluates the effectiveness of the plan of care in reaching desired outcomes and goals; makes modifications or changes in the plan of care as needed.
• Identifies trends and needs of groups in the community and plans interventions based on these identified needs.
• Provides care management services across sites and collaborates with appropriate facility discharge planner and/or HCC when members are transitioned between settings.
• Manages expenditures to ensure effective use of covered services within a capitated rate. Fiscally responsible in providing services based on members' needs.
• Provides social work services in accordance with NASW code of ethics, Agency policies, practices, and procedures.
• Participates in outreach activities to promote knowledge of the Program and its services and to coordinate Program activities with outside community agencies and health care providers (e.g., community health screening, In Services).
• Participates in the development of programs to meet the specialized needs of this selected patient population.
• Documents services in accordance with their standards and Managed Long Term Care (MLTC) and Licensed Home Care Services Agency (LHCSA) regulations.
• Participates in special projects and performs other duties as requested.