Social Worker/ Care Manager

Job Type: Contract (6+ months)

85% - Care Management

• Assesses member needs using a standardized health needs assessment or health risk assessment with the member.
• Performs comprehensive, disease-specific clinical assessments of all identified cases, at minimum annually, including assessment of the member's physical, functional, social and psychological status, cultural and linguistic needs, caregiver resources, and available benefits.
• Performs post-discharge assessments to identify member's post-hospital or post-ED discharge needs, including physical, functional, social and psychological status, cultural and linguistic needs, caregiver resources and available benefits, follow-up provider care and scheduled appointments, durable medical equipment and supplies, and community resources.
• Develops and implements member-specific care plans that include prioritized SMART goals.
• Continuously reviews, modifies and updates care plans to reflect member needs, at minimum annually or upon a change in condition.
• Schedules follow-ups to assess progress toward goals and identifies barriers to meeting goals.
• Provides regular outreach to assigned members and members from worklists and evaluates quality of service according to department contact standards.
• Coordinates care and services with members, family members or representatives, and other providers, as appropriate, including Community Supports and Long-Term Services and Supports (LTSS).
• Conducts face-to-face meetings outside CalOptima Health locations, including hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care settings, and members' homes, with members, family members or representatives, and other providers, as appropriate.
• Communicates with members' physicians, specialists, community agencies, and vendors to ensure coordination of services.
• Facilitates referrals to behavioral health and substance use disorder services and identifies and makes referrals to the Long-Term Services and Supports (LTSS) department, Community Supports, and community resources.
• Facilitates and participates in Interdisciplinary Care Team meetings, as applicable.
• Collaborates with interdepartmental staff in case resolution as needed.
• Identifies cases requiring manager, director, or medical director review or input, routes cases accordingly, and closes cases according to procedures and guidelines in a timely manner.
• Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan, as appropriate.
• Advocates in the member's best interest for necessary funding, treatment alternatives, timelines, coordination of care, and frequent evaluation of progress and goals.

10% - Administrative Support

• Participates in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term departmental goals and priorities.
• Follows CalOptima Health protocols for documenting all case interventions.
• Ensures timely reporting of productivity metrics to the supervisor.

5% - Other

• Completes other projects and duties as assigned.

• Bachelor's degree in social work, psychology, gerontology, public health, or social science, plus five years of clinical experience and/or managed care experience required.
• Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record, and current auto insurance are required for work away from the primary office 20% of the time or more.

Preferred Qualifications

• Licensed Vocational Nurse, Licensed Marriage and Family Therapist, or master's degree in social work, gerontology, public health, or a related field.
• Experience with behavioral health or substance use case management.
• Certified Case Manager (CCM) certificate.
• Bilingual in English and one of CalOptima Health's defined threshold languages: Arabic, Farsi, Chinese, Korean, Russian, Spanish, or Vietnamese.