Position Description:
The Case Manager, SW is responsible for planning, organizing, and directing the completion of projects related to improving clinical work on quality measures, practice transformation, outreach, and engagement with the providers as assigned. The Case Manager will identify, evaluate and report on program effectiveness and provide continuous process improvement feedback to the providers, the clinical quality team, and management.
The Case Manager, SW, under the direction of the Chief Medical Officer plans, organizes, implements, directs, and coordinates activities related to case management for our high-risk members. The Case Manager, SW is responsible for providing oversight, direction, and strategic planning for the operations of our member high-risk case management programs. Develop innovative strategies and tactics for engaging the high-risk members, their providers, and the network delivery system to ensure top-quality care is delivered to our patients. The Case Manager, SW works closely with the clinical quality team, clinical quality data and analytics team, networking, and SOMOS leadership to ensure that all high-risk members receive appropriate, high-quality healthcare.
Role Responsibilities:
Responsible for ensuring effective psychosocial intervention, positively impacting a patient's ability to manage his/her chronic illness.
Utilizes available community, government, and/or client resources needed to address the participant's limitations or support interventions in the management of the participant's chronic condition.
Manages behavioral and psychosocial needs that result in improved clinical and financial outcomes and delivers social work interventions.
Assists members in effectively utilizing available resources to meet their personal health needs and help them develop their own capabilities.
Evaluates members' ability to independently manage self and locate alternative resources when limitations are identified via a Social Work Psychosocial evaluation. Provides guidance to members seeking alternative solutions to specific social, cultural, or financial problems that impact their ability to manage their healthcare needs.
Evaluates members' strengths related to health self-management, develops strategies to support healthcare needs, and implements plans in support of case decisions.
Facilitates and coordinates behavioral health resources as individual member needs are identified.
COMPETENCIES AND QUALIFICATIONS
Minimum Requirements:
Requires MS (at a minimum) in Social Work and a minimum of 3 years of experience in case management in a healthcare environment; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted LMSW or LCSW (or equivalent) license in applicable state(s) required.
Bilingual (Spanish) or multi-language skills preferred.
Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
Ability to think critically, be decisive and problem-solve a variety of topics that can impact a member's outcomes.
Empathetic, supportive, and a good listener.
Proficient in motivational interviewing skills.
Demonstrated time management skills.
Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member.
Must have intermediate computer knowledge, typing capability, and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
Must embrace teamwork but can also work independently.
Strong communication (oral, written, presentation), relationship-building, planning, and implementation skills.
Demonstrated ability to handle projects independently, effectively, and efficiently. About SOMOS Innovation, LLC: Employees and Board Members of SOMOS Innovation, LLC only access PHI/EPHI on a need-to-know basis. Employees and Board members may only access confidential information that is authorized within their scope of duties and responsibilities and is responsible for the safeguarding of this information. SOMOS may periodically review, revise and/or revoke an employees or Board members privileges to access confidential (PHI) information.
Please note this job description is not designed to cover or contain all activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
$70,000 - $85,000