Social Worker, Population Health
2 weeks ago
**About The Role**
At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers - and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
**Primary Responsibilities**
- Support Medicare Eligible (MA) members in understanding enrollment options and provide education and guidance through the process.
- Supports RN with Clinical Outreach and Population Health Initiatives to improve engagement and overall well-being of members.
- Performs initial patient intake using appropriate screening criteria knowledge and clinical judgment to assess patient’s needs.
- Application and/or interpretation of applicable criteria and clinical guidelines, care management plans, policies, procedures and/or regulatory standards to ensure appropriate care planning.
- Engages medical providers in development of care plan to address objectives and goals as identified during assessment.
- Works with patient and providers to achieve better appointment and care compliance to prevent the incurrence of high cost or poor clinical outcomes; works to target the reduction of case complications through identification of high-risk triggers.
- Supports patient’s access to appropriate quality and cost-effective care.
- Monitors care plans for compliance with periodic follow up with provider and patient.
- Coordinates with external resources such as Pharmacy Benefit Manager (PBM), and Employee Assistance Plan (EAP) to meet identified needs of the patient and collaborates with providers.
- Help identify and interpret any trends including systemic issues, access or placement needs and recidivism, and facilitate access to behavioral health services, including assistance with locating providers and scheduling appointments as necessary.
- Documents all interactions and coordination efforts with both internal and external customers within the same day as the interaction.
- Presents cases at case strategy meetings. Participate in problem-solving of abrupt changes in care plan or non-compliant providers, and/or patients.
- Collaborate with internal Utilization Review team and engage colleagues, supervisors, Medical Directors as required by program protocols.
- Performs other duties as assigned.
**Essential Qualifications**
- Bachelor’s degree in social work, or equivalent experience.
- Current active unrestricted license as an LCSW (as applicable by state law and scope of practice)
- 2+ years of related case management, social work or behavioral health experience with solid clinical knowledge and experience with the treatment planning process, preferred, but not required.
- Knowledge of Medicare Enrollment Process and requirements.
- Basic knowledge of personal computer and software for word and excel processing and/or good keyboard skills preferred, or the ability to enter and retrieve data from relevant computer systems.
- Ability to effectively communicate with all levels of patients, physicians, health care personnel, supervisory staff, and peers.
- Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with mínimal oversight and direction.
- Demonstrates the willingness to research, learn, and obtain knowledge for the performance of the position.
- Demonstrates a courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.
**Preferred Qualifications**
- Excellent self-starter/self-management comfortable with ambiguity.
- Strong organizational and communication skills
- Demonstrate superb decision-making skills by engaging experts while determining alternatives and quickly synthesizing information, deriving insights, and devising solutions.
- Excellent team player with the ability to consistently demonstrate the highest levels of professionalism, integrity, mutual respect, and accountability to others; ability to maintain strong relationships across key stakeholders and constituents.
- Start-up mentality and comfortable innovating at a fast pa
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