Social Worker (Field – Must reside in Miami Dade County, FL)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Primary Job Duties & Responsibilities
Controls comprehensive management of members with acute or chronic conditions, including case management activities that focus on quality of care, compliance, outcomes and decreasing costs for individuals and communities.
Implements initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs under limited supervision to determine course of treatment.

Applies in-depth knowledge of case management concepts, principles, and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes.
Communicates updates and facilitates discussion with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of patients internally and externally.

Identifies opportunities to ensure the member receives all the necessary care allowed under the member’s benefit plan in home or community settings.
Provides information, resources, and education on social issues, mental health, and available services to raise awareness and empower individuals and communities.

Develops complex, innovative programs designed to reduce admissions for acute and chronic members, increase community integration, and improve health outcomes for enrolled patients and outside individuals.
Coaches more junior colleagues in techniques, processes, and responsibilities of social work to improve capacity.

Collaborates with community members, organizations, and policymakers to create opportunities for clients, address community issues, or raise awareness for specific issues.

Essential Qualifications
Basic awareness of problem solving and decision making skills.
Basic awareness of digital literacy skills.
Basic knowledge of medical terminology.
Ability to deal tactfully with customers and community.
Ability to handle sensitive information ethically and responsibly.
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.

Program Overview

This role will be 75% travel within a 50 mile radius- Miami Dade County.

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary

The Social Worker participates in the care planning process in collaboration with the Care Manager, to include the following actions: assessment, goal setting, establishing interventions related to goals, identifying barriers and strategies to address, monitoring success of the interventions, evaluating the success of the overall care plan and reporting outcomes.

Fundamental Components

• Care Management activities are conducted through a combination of telephonic and face to face interactions which include visits to member homes, in the community, facilities and/or provider locations
• Care management activities will focus on quality of care, compliance, outcomes and decreasing costs
• Responsible for developing and carrying out strategies to coordinate and integrate post-acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care
• Performs initial