California Annual Salary Range: $74,023 - $107,333

Job Summary

This position is responsible for working closely with the Health Services team and directly with members to assist with psychological and social care coordination needs. The Master’s prepared CM Social Worker addresses not only the psychosocial needs of members but also members’ linkage and eligibility to government programs, social services, and community resources. The CM Social Worker's responsibilities include but are not limited to communicating with members, providers, and community-based organizations; assisting pediatric members with special healthcare needs and their families to transition into adulthood, assisting with housing resources; referring to funding sources, identifying community resources to maintain members in the least restrictive environment and acting as a liaison between the Health Services Pediatric staff and California Children’s Services (CCS) Medical Therapy Program staff.

Duties and Responsibilities

• Responsible for the member-centered assessments/reassessments, covering psychosocial, rehabilitation, and environmental concerns

• Based on needs identified in an assessment, arranges, coordinates, and monitors services from different providers to serve member needs

• Conduct follow-up; monitor member’s needs and care plan; identify and develop a support system for the member

• Assist CCS members and their families with transition care planning from age 16 until 21 when members age out of CCS

• Evaluate the potential member as a total person and identify the functional limitations that impede independent living

• Provide resources and linkages to crisis management

• Develop individualized, member-centered care plans

• Consult with the Medical Director or the Nurse Care Manager as warranted on medical issues

• Refer members to specialized programs, such as Tri-County Regional Center (TCRC), County Behavioral Wellness (Health), Public Health, Family Service Agency (FSA)

• Consult and cooperate with community systems to facilitate linkage, referral, advocacy, and follow-up with a focus on attaining care plan goals

• Recommend improvements for the member’s functional level

• Maintain an active caseload providing interventions as needed within the area of expertise and limits

• Maintain a high level of ethical conduct and adhere to HIPAA and confidentiality regulations

• Participate in continuing education activities, remaining knowledgeable in the area(s) of expertise

• Participate in CCS Medical Therapy Unit Conferences and address identified psycho-social issues of members and their families

• Other duties as assigned

Skills/Knowledge/Abilities

Required:

• Demonstrate expertise and ability to function as a care manager as evidenced by experience

• Ability to clearly and effectively communicate and negotiate with members and families, physicians, and other health care providers

• Self-motivated to seek knowledge in order to improve personal and professional performance

• Ability to work effectively in a cross-functional team environment

• Strong computer literacy and skills

• Excellent verbal communication and writing skills required

• Knowledge of existing community resources and ability to effectively link members to agencies

Preferred:

• Knowledge of managed care issues (including benefits and contract limitations, delivery, and reimbursement systems), and the role of medical management activities

• Knowledge of State and Local social service agencies and community-based organizations

• Current crisis prevention/intervention certification

• Commission for Case Management Certification (CCMC)

• Knowledge and skills in community-based behavioral health care resources

• Knowledge of the unique medical and psycho-social problems of children and young adults with disabilities and special healthcare needs

• Bilingual in Spanish

Education and Experience

Required

• Requires a minimum of a Master’s degree in Social Work, Clinical Psychology, or Psychology. A concentration in Gerontology, pediatrics, Public Health, Substance Abuse, Mental Health, or other related fields is preferred

• Requires a minimum of three (3) years of clinical work experience in the above field.

• Licensed Clinical Social Worker license substitutes for two years of work experience

• Experience with providing services and addressing problems of children and young adults with disabilities and special healthcare needs

• Minimum of one (1) year in a managed care or health plan setting, Medi-Cal or Medicaid preferred

• Minimum of one (1) year in case management and care coordination preferred

• Experience in developing member-centered individualized care plans