Our Healthcare Insurance client is seeking a Case Manager, Social Work to join their team for a contract role!
Our client has over 5,000 employees and is the number 1 health insurer in the state of North Carolina, serving more than 3.88 million customers.
Health care is changing, and our client is leading the way by providing innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.
Position: Case Manager, Social Work
Location: ** While the position is Remote, work from home, to be eligible to convert to an employee of this company, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Term: 3+ months
Hours: 8-5 daily except for 1 day a week resource will be required to work a night shift, hours for late evening shift is 11-7:30. Required to do 1 or 2 Saturdays a year
- Masters Social Worker required but would also need and prefer a LCSW.
- 3+ years of experience in related field.
- In lieu of degree, 5+ years of experience in related field
- Current, valid ASWB Social Work certification in North Carolina.
- Telephonic CM Experience
The Social Work Case Manager coordinates the care and service of selected patient populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a leadership role with all members of the healthcare team to achieve optimal clinical and resource outcomes.
- Serves as a team member on a multidisciplinary Health Care Coordination team that identifies and facilitates appropriate health care service delivery for selected patients, providers, procedures, and/or diagnoses; and improves the quality and cost efficiency of care and service.
- Performs a comprehensive assessment of the members health status, educational, and level of support needs. The assessment includes condition specific issues, clinical history, medications, activities of daily living, mental health status, cognitive functioning, life planning activities, cultural and linguistic needs, caregiver support and resources.
- Develops a member centric care plan which includes long and short term goals, a self management plan tailored to members needs, and identification of barriers to meeting goals or compliance to plan of care.
- Performs ongoing monitoring and management of member which includes: scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation to MD, MSW, HLB, etc; assessment of progress towards goals, modification of plan/goals as needed, nurse contact at least every 30 days, complete documentation of calls and faxes with phone and fax numbers.
- Evaluates and facilitates care provided to members as they move through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care). Reviews alternative treatment plans for case management candidates, and assesses available benefits and need for benefit exceptions or flex benefit options.
- Encourages pro-active intervention to limit expense and encourage positive outcomes.
- Maintains awareness of community resources and funding. Utilizes these resources and funding sources in the development of the care plan.
- Collaborates with primary care physician, On-Site Medical Care Coordinator, Discharge Services, Medical Director, Episodic Care Managers, the patient, patient family members and other members of the health care team to develop appropriate plan of treatment and discharge plans. This includes understanding of family dynamics, empowerment and the impact of personality traits as they relate to the discharge planning/case management process.
- Documents all aspects of the plan from the initial assessment, development of the plan, implementation, including monitoring and evaluating outcome. Completes all correspondence related to case management. Obtains consents as indicated. Analyzes and reports case management activity according to department policy.