Social Worker Care Manager II

*This position will require employees to be in the field (D.C) four (4) days a week and 1 day remote.*

Under the direction of the Senior Care Manager, the Care Manager (CM) is responsible for providing comprehensive care coordination services to members who are enrolled in the Health Services for Children with Special Needs (HSCSN) health plan. The CM routinely communicates with members on their assigned caseload to assess their needs; develop, monitor and evaluate treatment plan progress; and assist with coordinating care and referring to appropriate services for members who have moderate to complex medical and psychosocial needs.

Minimum Education
Master's Degree (Required)

Minimum Work Experience
3 years or more years of healthcare or related experience in managed care and /or care management (Required)
3 years or more years experience in clinical or community resource settings (Required)

Required Skills/Knowledge
Effective verbal and written communication skills
Bilingual (Spanish speaking) preferred
Familiar with medical terminology
Proficiency with computer systems and applications, particularly in Microsoft Office suite
Strong organizational skills
Ability to interpret and apply departmental requirements
Ability to make sound decisions and use good judgment
Ability to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service
Ability to participate in professional, multidisciplinary meetings to include internal and external staff meetings

Required Licenses and Certifications
Licensed in DC as a Licensed Independent Social Worker (LICSW) (Required)

Job Functions
Essential job duties:

• Manages a caseload as outlined by CASSIP and Care Management Leadership.

• Maintains compliance in accordance with contractual and care management requirements

• Contacts enrollee at predetermined intervals based on stratification level or more frequently, as needed.

• Conducts face-to-face visits at a frequency determined by the enrollee’s assigned stratification level or more if needed, with each enrollee/caregiver in their homes, physician’s offices, or other mutually agreed upon locations.

• Assesses enrollees on enrollment and at intervals determined by the enrollee’s stratification level to identify needs/barriers and close gaps in care.

• Identifies over/under utilization promptly, and takes appropriate action according to organizational policy.

• Upon gathering health and mental/behavioral health, environmental, psychosocial and educational information, the CM develops, implements, and updates an accurate individualized comprehensive care coordination plan for each assigned enrollee in collaboration with the PCP and/or other multi-disciplinary team members including public agencies.

• Completes routine care coordination and care management activities with attention to quality, timeliness and in compliance with company policy and national standards.

• Consults with Senior Care Manager to review and prioritize cases, set objectives, identify, and report potential risk and utilization concerns.

• Seeks advice from Senior Care Manager or other designated person with expertise in specialty areas when necessary.

• Accurately and timely documents enrollee findings and interactions according to organizational policy.

• Receives supervision by licensed staff according to oversight guidelines.

• Understands and abides by HSCSN’s Confidentiality policy and procedure regarding enrollee specific information.

• Participates in disposition and discharge planning activities. Contributes to the discharge plan in a timely manner, taking into consideration enrollee/family/significant others and match to healthcare resources.

• Clearly communicates verbally and in writing.

• Assists/empowers caregivers or enrollees to participate in care of child /self.

• Assists assigned enrollees and their caregivers in understanding the importance of EPSDT and compliance with all health services. Strives to achieve target rate of compliance for preventive medical and dental services.

• Assists with scheduling and monitors the compliance of mental health/medical appointments. Follows department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents including communication to primary care provider or specialist.

• Applies advanced knowledge of conditions of target population/standard approaches to care management and care coordination to assigned enrollees.

• Attend multidisciplinary meetings as necessary, including off-site meetings with other involved agencies.

• Receives and reviews reports of visits by vendors or contracted providers to enrollees receiving services and facilitates coordination of follow-up care, as needed.

• Refers enrollee/caregiver to appropriate vendor(s) on DME/assistive technology use. Educates on medication administration, about their conditions, and techniques for self-management within the scope of license. Refer, as needed, to appropriate vendor for additional education.

• Assist enrollees in planning for transitions of care to include but not limited to transitioning from Early Intervention to DCPS; from pediatric to adult providers; transitioning out of HSCSN when the enrollee ages out or is disenrolled for any reason; from outpatient to inpatient or the reverse; and entering or exiting the custody of CFSA, DYRS or any type of institutional care.

• Enters authorizations for services requiring authorization by Care Management staff.

• Keeps abreast of changing strategies and trends in care coordination and care management.

• Uses communication skills which promote understanding and collaboration with enrollees and their families, HSCSN staff, providers and others.

• Positively presents accurate information about HSCSN to enrollees and their families, HSCSN staff, providers, coworkers and the community.

• Maintains professional, courteous and customer focused demeanor in all interactions.

• Demonstrates knowledge of medical terminology and health care delivery systems.

• Applies time management and organizational skills effectively.

Care Manager (Special Populations):

• The responsibilities of the Care Management staff assigned to these populations are inclusive of the duties outlined above with further detail in their respective program description and/or policy.

Other job duties:

• May perform other duties in addition to those outlined in this job description

Organizational Accountabilities
Organizational Accountabilities (Staff)
Employee Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved

• Innovates through improvement of care and/or efficiency of operational processes.

• Dedicated to a standard of performance excellence and high quality

All In

• Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency

• Identifies, prioritizes and selects alternative solutions to determine best outcome

Action Oriented

• Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands

• Anticipates problems and attempts to solve before they develop

Supervisory Responsibilities

• None

Blood Borne Pathogen Exposure

• Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

Protected Health Information Access Level

• Level IV - Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.

Working Environment

• This job operates in an office environment.

Physical Requirements

• Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Travel Requirements

• Requires frequent local travel. External applicants as well as position incumbents must have a vehicle or access to a motor vehicle.

DC Residents Encouraged to Apply