Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Social Worker

📁
Manager & Professional
💼
ConnectiCare
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Summary of Job:
Achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness, members who are frail elderly and/or members whose illness is complicated by challenging psychosocial conditions. Provide global, episodic, specialized or complex care management and utilization management as needed to ensure coordination of health care delivery, member education, and preventative intervention.  
Coordinate care in a variety of settings and provides focus on transition activities to benefit clinical needs of members while performing the care management process.  Assist in managing members with behavioral health, substance abuse, and/or psychosocial conditions/issues, consulting with and referring to colleagues across the enterprise and vendor/delegates on behavioral health, substance abuse, and/or psychosocial issues. 
Facilitate member adoption of strategies to promote physician recommended behavior changes; help members improve health outcomes and provide feedback to members of the medical and care management care teams. Performing telephonic or face-to-face assessments of members’ health care needs, identifying gaps in care and needed support, administering/coordinating authorization and concurrent review processes and coordinating implementation of interventions. Screen, assess and support members related to impacts to social determinants of health (SDOH)
Ensure that all processes and reporting are compliant with all applicable federal and state regulations, and NCQA and ConnectiCare standards.
 

Requirements:

  • Develop, facilitate, and communicate a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various providers.
  • Provide care management through assessment, planning, implementation, coordination, monitoring, and evaluation to ensure member receives services and support required to meet psychosocial, educational and health care needs.
  • Assist members with the coordination of services from various settings as appropriate including facilitating supporting discharge from acute setting to home and acute setting to alternate settings.  
  • Provide Care Coordination throughout the continuum of care by including the member, member’s family and providers in the process.
  • Assess identified members to determine members appropriate for management early in their disease process at any time during the continuum of care.
  • Assesses members Social Determinants of Health, such as housing, food, transportation and safety in the home and assesses members Mental health needs including PHQ2 and 9 Depression screening, Provides mental health counseling referrals, and provides appropriate support as needed. 
  • Optimize both the quality of care and the quality of life for the member.  
  • Identify members appropriate for specialty programs.     
  • Work collaboratively with other clinical and ancillary staff.
  • Other duties/projects as assigned.
  •  

Qualifications:

  • Bachelor’s degree;
  • Masters in social work (LMSW) required/Certification in clinical social work (LCSW) preferred 
  • Minimum 4-6 years care management and/or managed care experience (R)
  • Knowledge of Federal and State regulations for Medicare and Medicaid and other national and state funded programs (R)
  • Knowledge of community resources access (R)
  • Proven track record in leading care management team(s) (R)
  • Health plan experience highly desirable (R)
  • Strong problem-solving skills (R)
  • Detailed oriented and organized (R)
  • Excellent written and oral communications skills. (R)
  • Strong Motivational interviewing skills (P)
  • Strong working knowledge of Microsoft Office applications (word processing, database/spreadsheet, presentation) (R)
  • Bilingual English/Spanish (P)
  • Must have regular and reliable transportation (R) 

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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