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  • 6201 San Ignacio Avenue
    San Jose, CA 95119
  • Laura Barrientos

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Social Work Case Manager

Santa Clara Family Health Plan • San Jose, CA

Posted 23 days ago

Job Snapshot

Experience - 3 years
Healthcare - Health Services
Health Care

Job Description

Consider a career at Santa Clara Family Health Plan (SCFHP), a public, not-for-profit plan of over 250,000 members serving Santa Clara County.



The Social Work Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate the Social Work Case Manager facilitates communication and coordination among all participants of the care team, to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the Social Work Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitates the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.



To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Conduct, review and document comprehensive clinical and/or psycho social assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psycho social, environmental, safety, developmental, cultural and linguistic needs.

2. Maintain case files by ensuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements.

3. Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals.

4. Coordinate member’s care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community.

5. Facilitate and coordinate communication with member’s interdisciplinary care team including SCFHP internal staff, as well as the member’s physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.

6. Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review.

7. MLTSS Social Work Case Manager is responsible for conducting the MLTSS Assessment Review process and overseeing and coordinating directly with MLTSS providers serving members, as well as supporting the care transition of long-term care members.

8. Build and maintain relationships with key community-based housing, social service and public providers to facilitate appropriate referrals.

9. Represent SCFHP in interactions with community stakeholder meetings.

10. If assigned to Behavioral Health, provide care coordination with Specialty Mental Health providers and follow up with members being discharged from psychiatric hospitalization; ensure psychiatric care was received and an appropriate transition plan is in place.

11. Behavioral Health Social Work Case Manager is responsible for care coordination with Specialty Mental Health cases under Cal-Medi-Connect.

12. Conduct telephonic and/or visits/assessments, as needed in the home, facility, community setting or Health Plan office.

13. Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction.

14. Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed.

15. Perform other duties as required or assigned.

Job Requirements

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Master’s Degree in Social Work, or related field. 

2. Clinical Social Work License without restriction, or ability to acquire License within two years. 

3. Minimum three years of experience in social work, behavioral health, or case management, or education or certifications, or equivalent experience. 

4. Ability to build and manage relationships with community-based and public agencies supporting care coordination. 

5. Knowledge of long- term services and supports, behavioral health and/or relevant public services and community resources. 

6. Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. 

7. Ability to work within an interdisciplinary team structure. 

8. Ability to conduct home, facility and other community-based visits. 

9. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. 

10. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. 

11. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. 

12. Ability to use a keyboard with moderate speed and a high level of accuracy. 

13. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. 

14. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. 

15. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position.

16. Ability to maintain confidentiality. 

17. Ability to comply with all SCFHP policies and procedures. 

18. Ability to perform the job safely and with respect to others, to property and to individual safety. 


Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. 

Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). 


Santa Clara Family Health Plans offers a comprehensive benefits package including PTO, holidays, fitness center membership, medical, dental and vision coverage, CalPERS retirement, 401a and 457 Deferred Compensation retirement plans.


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