Field Social Worker - TPA

Location: Detroit, MI
Date Posted: 02-01-2018
Field Medical Social Worker (BSW or MSW or LBSW or LMSW) - Managed Care
Detroit, MI
Job Summary:
As a member of the medical management team, the Social Work Case Manager plays an integral part in the coordination of care assessing the patient's condition and providing them the necessary resources, options, and coordination for a healthy care outcome. The primary responsibility of the Case Manager is to coordinate and monitor the care of patients and develop a nursing plan of care. They will participate in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency. The Case Manager also acts as an advocate for patients and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward a maximum level of independence. The Case Manager works specifically with the home health / home care population, generally conducted via telephonic interaction combined with remote monitoring / telehealth equipment.  Position does require regular (at least once per month) on-site visits to assess patient's care in their home.
Position Description:
Develops individual treatment plans and makes recommendation for members. Implements treatment plan using appropriate modalities, including individual counseling, medication monitoring, crisis intervention, community contacts, diversion and triage. This can be achieved by meeting with the member or responsibly party in the clinic, acute, SNF, or home setting.  Attends and contributes to Team Conferences regarding care to/for specific member.  Responds to requests from Concurrent Review or Case Managers to evaluate members in the skilled setting to who have been determined as potentially unsafe for discharge. Will work with the facility’s Social Worker to provide a safe discharge plan prior to member’s discharge.  Will consult upon request of clinical or educational staff members and accept referrals from Case Management or PCP office, for members needing resource information.  Prepares reports and compiles statistical data regarding members, as determined by the management team.
Promotes Basic Needs Assessment; clothing, housing/homeless prevention, limited financial resources, home maintenance repair, referrals, food, safety in the home, transportation, and utilities assistance.  Assists with application for MediCal, insurance enhancements, prescription referral source, education on a variety of issues, including: how to obtain medical equipment, hospice choices, dental care referral source, non-compliant issues, and any psychiatric conditions interfering with medication regiment.  Provides Family and Social Support, including: limited social support, parenting education skills, domestic violence, elder care, parent-child conflict, family relations issues, and recreational activities.  Conducts Mental Health assessments and provides referrals to: individual therapy, family therapy, group therapy, anger management, behavior management, suicide prevention and alcohol or substance abuse.  Provides evaluations when requested for all members referred by Case Managers, Concurrent Review nurses, Medical Directors, or PCPs, regarding possible placement or member financial concerns.   Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.
Background Profile:
Requires a Degree in Social Work and a valid, unrestricted state license as a social worker, either as a Licensed Bachelor Social Worker (BSW / LBSW) or an Licensed Master Social Worker (MSW / LMSW).
Strong working knowledge of case management/care coordination processes and principles is needed.
Prior experience in a Managed Care environment is preferred.
Must have fairly strong computer skills; must be fully proficient in MS Word,with professional writing styles, and basic MS Excel.
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Required to travel for member appointments, so must have current driver’s license and insurance.
The Reward:
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health.
Mike Vega
Search Consultant

CareNational Healthcare Services

480-264-0620 (CALL – TEXT – FAX)
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