Degreed Social Worker
3 weeks ago
Job ID #1674902
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About this Role
Assists in developing, assessing, and coordinating holistic care management activities to enable quality, cost-effective healthcare outcomes. May develop or assist with developing personalized service care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.
Job details
$28.00 / hour
New Port Richey or Port Richey, Florida
Profession: Degreed Social Worker
Facility Type: ???
Specialty: Health Plan
Division: MedFi
Start Date: 11/12/2024
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Responsibilities
• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
• Assists with developing ongoing long-term care plans/service plans and works to identify providers, specialist, and/or community resources needed for long-term care
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Provides resource support to members and their families/caregivers for various needs
• Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
• Interacts with long-term care healthcare providers and partners as appropriate to ensure member needs are met
• Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners
• Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
Required Qualifications
2+ years case management experience
Experience with electronic medical records
Strong computer skills - MS office
Bachelor's Degree
Home health exp preferred
Long term care exp preferred
Discharge planning exp preferred
Bilingual preferred
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