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Healthcare Case Manager
2 months ago
The Social Work Case Manager is a key member of the Mount Carmel Health System team, responsible for coordinating medical care for Plan members with healthcare providers, family, and other resources as needed. This role requires strong communication and problem-solving skills, with the ability to work independently and adapt to changing regulatory requirements.
Key Responsibilities- Coordinates with case management resources to develop and document treatment plans for members who meet the Plan's guidelines for Case Management.
- Conducts behavioral health, substance abuse, and psychosocial assessments of members' health status, including medical history, medications, and symptoms.
- Consults with members to set negotiated goals and determines the frequency of interaction.
- Provides telephone follow-up and teaching to promote goal attainment, as well as providing educational materials appropriate for the member's condition.
- Assists members in advocating for their healthcare and helps them formulate questions to ask their physician, as well as how to respond to common symptoms.
- 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.
- Collaborates with Claims, Member Services, Grievance Coordinator, and other operational departments regarding case management issues.
- Applies knowledge of local state and federal programs to link members and their caregivers and families to appropriate community resources.
- Master's degree in Social Work (MSW) from an accredited program.
- State licensure in Social Work (LSW) in the State of Ohio required, LISW preferred.
- Minimum of 2 years of case management experience across behavioral health or related fields, with knowledge of basic medical terminology and basic computer skills.
- Effective communication and problem-solving skills, with the ability to work independently and adapt to changing regulatory requirements.
- Medical Social Work experience required.
- Ability to implement and successfully utilize Case Management software.
Mount Carmel Health System is a not-for-profit healthcare organization dedicated to providing excellent patient care and service to our community. We are committed to diversity, equity, and inclusion, and strive to create a workplace that values and respects the unique experiences and perspectives of our colleagues.