Social Work Case Manager Health Plan
4 weeks ago
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.
What we offer:
- Competitive compensation and benefits packages including medical, dental, and vision coverage
- Retirement savings account with employer match starting on day one
- Generous paid time off programs
- Employee recognition incentive program
- Tuition/professional development reimbursement
- Relocation assistance (geographic restrictions apply)
- Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing
Why Columbus?
The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest - ranked for population growth, for job growth, for wage growth, and real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more at
About the job:
The Social Worker Case Management is responsible for the coordination of the medical care provided to Plan members with Plan providers, the member's family and other resources as appropriate. Assist in the implementation of Case Management software along with the Plan's UM and QM Program and the review of the Plan's Medical Management Plan.
What you'll do:
- Meets population specific and all other competencies according to department requirements.
- Relationship-based Care: Creates a caring and healing environment that keeps the member and family at the center of care throughout their experience with MediGold.
- Coordinates with case management resources to assure development and documentation of a treatment plan for members who meet the Plan's guidelines for Case Management and collaborate the plan to the member's PCP and/or other members of the interdisciplinary team internally and externally when appropriate.
- Completes an behavioral health, substance abuse and/or psychosocial assessment of the member's health status, including medical history, medications, and symptoms, degree of support from family & friends, and current treatment prescribed by the member's physician.
- Consults with member to set negotiated goals and determine the frequency of interaction.
- Provide telephone follow up at the frequency agreed upon and teaching to promote goal attainment as well as providing educational materials appropriate for that member's condition.
- Assist member to be an advocate for their healthcare and assist with formulating questions to ask the physician, as well as how to respond to common symptoms they might experience.
- Creates and maintains a case management database of referrals and treatment plans for Members.
- Coordinates with Medical Director/Associate Medical Directors on case-specific issues.
- Coordinates with Claims, Member Services, Grievance Coordinator and other operational departments regarding case management issues.
- Apply knowledge of local state and federal programs to link members and their caregivers and families to appropriate community resources.
What we're looking for:
- Minimum Education Requirement: Completion of Masters program in Social Work
- Licensure Requirement: Licensure / Certification: LSW state licensure in the State of Ohio required, LISW preferred.
- Experience: Minimum of 2 years of case management experience across behavioral health or related fields. Knowledge of basic medical terminology and basic computer skills.
- Effective Communication Skills
- Medical Social Work experience required.
- Effective problem solving, organizational and time management skills with the ability to consistently work in a fast-paced environment.
- Possess excellent clinical, organizational and analytic skills, which enable this position to function independently and be able to adapt to rapidly changing regulatory requirements.
- Proven ability to work independently, with attention to accuracy and consistency of information obtained and recorded.
- PC computer skills including web navigation and research skills required.
- Possess effective verbal written and interpersonal skills, can work across departmental boundaries, facilitate problem resolution and maintain a professional demeanor in difficult situations.
- Ability to implement and successfully utilize Case Management software.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
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