Case Manager Licensed Social Worker

Overview

 

Ready to Transform Lives Through Comprehensive Care Coordination and Advocacy?We're seeking a compassionate social work professional who can telephonically manage cases while addressing the full spectrum of patient needs—physical, psychosocial, emotional, spiritual, environmental, and financial. As our Case Manager, you'll develop treatment plans for standard and catastrophic cases while advocating for patients, facilitating quality care delivery, and implementing cost management strategies that achieve optimal outcomes.

 

Responsibilities

What makes this role different ✓ Holistic assessment: Conduct thorough evaluations addressing physical, psychosocial, emotional, spiritual, environmental, and financial needs ✓ Complex case management: Develop treatment plans for both standard and catastrophic cases in collaboration with patients, caregivers, and multidisciplinary teams ✓ Cost management expertise: Negotiate and implement strategies that affect quality outcomes while documenting cost avoidance and intervention effectiveness ✓ Advocacy focus: Champion patient needs by facilitating quality care delivery and providing emotional support and guidance throughout care continuum  What You'll Actually Do   Manage comprehensive cases: Telephonically coordinate cases on long- or short-term basis per established guidelines, policies, and healthcare industry standards. Conduct holistic assessments: Complete thorough patient evaluations including physical, psychosocial, emotional, spiritual, environmental, and financial needs assessment. Develop treatment plans: Create collaborative treatment plans for standard and catastrophic cases with patients, caregivers, family, community resources, and multidisciplinary healthcare providers. Monitor and evaluate outcomes: Track interventions and evaluate treatment plan effectiveness promptly while reporting measurable outcomes that record intervention success. Maintain care coordination: Initiate and sustain contact with patient/family, providers, employers, and multidisciplinary teams throughout continuum of care. Advocate for patients: Facilitate delivery of quality patient care while assisting in reducing overall costs and providing emotional support and guidance to patients and families. Implement cost strategies: Negotiate and execute cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews and cost avoidance reports. Build strategic relationships: Establish and maintain working relationships with healthcare providers, clients/groups, and patients to provide comprehensive support. Maintain comprehensive documentation: Record detailed case information in Eldorado and UM Web, maintain confidential site-specific files, and prepare reports at 30-day intervals per HIPAA requirements.

 

Qualifications

What You Bring to Our Mission   The social work foundation:

• Graduation from accredited college with degree in Social Work required
• License in Social Work required
• Must apply for certification in case management after one year at Personify Health
• Minimum 2 years acute healthcare experience including 2 years case management experience, or equivalent combination of education and experience

  The technical competencies:

• Basic computer literacy with ability to work on multiple screens and proficient typing skills
• Proficiency in Microsoft Word, Microsoft Excel, and Outlook
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Ability to work independently and utilize written resources to problem-solve

  The professional competencies:

• Excellent verbal and written communication skills for upward and downward conversations
• Ability to speak clearly and convey complex or technical information in understandable manner
• Capability to understand and interpret complex information from others
• Ability to meet productivity, quality, and turnaround time requirements daily, weekly, and monthly
• Evidence of innovative thinking with ability to assist with department operations and implementations

  The compliance standards:

• Ability to pass external audits including URAC and NCQA
• Maintain HIPAA compliance per company policies and procedures
• Maintain confidentiality and minimum requirement rules
• Complete all required yearly training per company's expected timeframe
• Additional training, certification, or degree outside of compa