Care Management Social Worker

3 weeks ago

Tacoma, Washington, United States Cambia Health Solutions Full time

About the Role:

Cambia Health Solutions is seeking a skilled Care Management Social Worker to join our Clinical Services team. As a member of this team, you will provide clinical care management to best meet the member's specific healthcare needs and promote quality and cost-effective outcomes.

Key Responsibilities:

  • Conduct case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs.
  • Apply clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of their license.
  • Collaborate with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
  • Serve as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues.

Requirements:

  • Master's degree in Behavioral Health (for behavioral health care management) or related field 3 years of case management, utilization management, disease management, or behavioral health case management experience
  • Equivalent combination of education and experience
  • Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care

What We Offer:

  • Knowledge of health insurance industry trends, technology and contractual arrangements.
  • General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
  • Strong oral, written and interpersonal communication and customer service skills.
  • Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
  • Strong organization and time management skills with the ability to manage workload independently.
  • Ability to think critically and make decision within individual role and responsibility.

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