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Job Requirements

Knowledge, Skills, and Abilities: 

• Bachelor’s or master’s degree in Social Work required with active, unrestricted RSW or MSW license

• Minimum 2 years of experience in the social service field

• Minimum 1 year of case management experience preferred

• Familiarity with HEDIS, NCQA, and star measures

• Experience in corporate office setting preferred

• Proficient in Microsoft Office Suite (Excel, Word, Power Point, etc.) 

• Ability to type minimum of 40 WPM preferred

• Highly organized and efficient with strong attention to detail

• Ability to multitask and prioritize in a fast-paced, ever-evolving environment

• Excellent verbal and written communication skills

• Ability to interact effectively with all levels of staff

• Must have valid driver’s license with clean driving record and ability to drive locally


Supervisory Responsibilities:

• This position has no supervisory responsibilities


Supervision Received: 

• Works under general supervision of the Director of Integrated Care


Working Conditions:

• This position operates in a professional office environment with opportunity to work from home upon meeting training, eligibility, and performance requirements as deemed appropriate by management 

• The position conducts in-home and hospital visits

• This is a full-time position (40 hours/week)

• Overtime may be required 


Physical Requirements: 

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.


While performing the duties of this job, the employee is required to remain in a stationary position for long periods of time and must frequently move about the office. The employee is required to frequently operate a vehicle. The employee must constantly operate a computer and other office equipment such as phones, keyboards, printers, and copiers. The employee is regularly required to communicate with others via phone, email, etc. Occasionally, the employee is required to move up to 10 pounds and may, at times, be required to move up to 50 pounds. 


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Quality Assurance Social Worker (RSW/MSW) at Vantage Health Plan, Inc.

Quality Assurance Social Worker (RSW/MSW)

Vantage Health Plan, Inc. Monroe, LA Full-Time
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At Vantage Health Plan, we specialize in taking care of people: our members, our patients, and our employees. We offer competitive salaries and great benefits! Benefits include: Health, Dental, Life, Accidental Death and Dismemberment, Long Term Disability, Paid Time Off, and 401(k).

Job Summary: The Quality Assurance Social Worker (QASW) is responsible for connecting members to person-centered community resources and programs to meet their individual needs on a social and clinical level. The QASW is responsible for developing and implementing programs to meet HEDIS, NCQA, and Star ratings measures for Vantage and Blue Cross. The QASW assesses member needs to ensure that proper resources are provided and assists with available services to help improve overall health and well-being.


Essential Duties & Responsibilities:

• Identify members who have gaps in care

• Conduct home and hospital visits to members to assess needs

• Conduct assessment and screening to identify needs

• Connect member to resources to promote compliance and improve health

• Document contact made with members/patients and services provided in Acuity and Centricity systems based on referral source

• Participate in Quality Assurance committee meetings

• Perform follow-up on cases as needed to evaluate effectiveness

• Conduct face to face visits as needed

• Maintain effective team member relations

• Adhere to all documentation guidelines

• Maintain professional relationships with provider community and internal and external customers


Marginal Duties:

• Attend regular staff meetings

• Participate in appropriate case management conferences or learning activities to maintain current social work license and to enhance skills/abilities and promote professional growth.

• Other duties as assigned


Knowledge, Skills, and Abilities: 

• Bachelor’s or master’s degree in Social Work required with active, unrestricted RSW or MSW license

• Minimum 2 years of experience in the social service field

• Minimum 1 year of case management experience preferred

• Familiarity with HEDIS, NCQA, and star measures

• Experience in corporate office setting preferred

• Proficient in Microsoft Office Suite (Excel, Word, Power Point, etc.) 

• Ability to type minimum of 40 WPM preferred

• Highly organized and efficient with strong attention to detail

• Ability to multitask and prioritize in a fast-paced, ever-evolving environment

• Excellent verbal and written communication skills

• Ability to interact effectively with all levels of staff

• Must have valid driver’s license with clean driving record and ability to drive locally


Supervisory Responsibilities:

• This position has no supervisory responsibilities


Supervision Received: 

• Works under general supervision of the Director of Integrated Care


Working Conditions:

• This position operates in a professional office environment with opportunity to work from home upon meeting training, eligibility, and performance requirements as deemed appropriate by management 

• The position conducts in-home and hospital visits

• This is a full-time position (40 hours/week)

• Overtime may be required 


Physical Requirements: 

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to satisfactorily perform these essential functions without causing an undue hardship for the employer.


While performing the duties of this job, the employee is required to remain in a stationary position for long periods of time and must frequently move about the office. The employee is required to frequently operate a vehicle. The employee must constantly operate a computer and other office equipment such as phones, keyboards, printers, and copiers. The employee is regularly required to communicate with others via phone, email, etc. Occasionally, the employee is required to move up to 10 pounds and may, at times, be required to move up to 50 pounds. 


Recommended Skills

Hedis
Medicare
Msw
Ncqa
Rsw
Social Work
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