Job Title: Social Work Care Manager (LMSW)

Experience: clinical, case management, health home background, Homeless/Shelter background

Caseload: ~250 members. SW will have a CMSC partner and every month they will swap outreach calls to half the membership unless something clinical comes up.

This is strictly Medicaid care management but they will work with other Medicare plans for coordination or benefits as well.

Location: Mainly remote (could be asked up to 6 times a year in the office and that could increase. They ask for their flexibility).

Schedule: Mon-Fri, 8:30-4:30pm

Pay: $37-41/hr

Summary:

Provides care management through a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet members 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 managed care system. Closely communicates and collaborates with primary care practitioners, interdisciplinary team and family members.

Job Description:

• Assesses, plans and provides intensive and continuous care management across acute, home, and longterm care settings.
• Develops and negotiates care plans with members, families and physicians.
• Assesses a persons living condition situation, cultural influences, and functioning to identify the individuals needs develops a comprehensive care plan that addresses those needs.
• Assesses an enrollees 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 members 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 ongoing 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.