Social Worker Case Manager

Location: Pasadena, CA

Required Skills & Qualifications

• Applicants must be able to work directly on W2.
• Master's Degree in Social Work is mandatory.
• Minimum of 2 years of experience as a Social Worker.
• Prior experience in the healthcare industry is essential.

Day-to-Day Responsibilities

• Plan, develop, assess, and evaluate care provided to members.
• Conduct baseline medical and psychosocial evaluations and create individualized patient care/treatment plans with primary care and specialist physicians.
• Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
• Develop and maintain case management policies and procedures.
• Coordinate care/services with utilization and/or quality reviewers and monitor the level and quality of care.
• Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining necessary authorizations/approvals/transfers for outside services for patients/families.
• Consult with internal and external physicians, healthcare providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• Arrange and monitor follow-up appointments.
• Encourage members to follow the prescribed course of care (e.g., drug therapy, physical therapy).
• Make referrals to appropriate community services and outside providers.
• Identify and recommend opportunities for cost savings and improving the quality of care across the continuum.
• Develop and collect data; trend utilization of healthcare resources.
• Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Coordinate transmission of clinical and benefit treatment to patients, families, and outside agencies.
• Act as liaison for outside agencies, non-plan facilities, and outside providers.
• Coordinate repatriation of patients and monitor their quality of care.

Company Benefits & Culture

• Inclusive and diverse work environment.
• Opportunities for professional growth and development.
• Supportive team culture.

Please reach out at  ritika.singhal@artech.com for more details.