Social Worker

2 weeks ago


Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time
CareFirst BlueCross BlueShield Job Description

Job Title: Social Worker

Job Summary:

CareFirst BlueCross BlueShield is seeking a skilled Social Worker to join our Care Management team. As a Social Worker, you will play a critical role in supporting our Care Managers, Supervisors, Manager, and Director of Care Management in providing high-quality care to our members.

Key Responsibilities:

  • Identification/Risk Stratification: Engage members into Care Management using diagnostic cost grouper classification reports to identify relative risk scores, illness burden, and high-intensity care needs.
  • Assessment: Gather clinical information, including past medical history, medications, physical/psychosocial factors, cultural influences, and evaluation of healthcare barriers to assess members' medical and behavioral health needs.
  • Planning: Utilize proficient Care Management clinical knowledge and experience to coordinate integrated care-plan development involving members, family, Hospital Transition of Care (TOC) nurse, Care Coordination (CC), Care Manager (CM), Primary Care Physician (PCP), specialists, and other healthcare providers/vendors as appropriate.
  • Facilitation of Communication and Care Coordination: Execute the transition of care to minimize fragmentation and adverse outcomes, and complete a review of service requests containing all necessary information to allow the medical director to make a medical necessity determination.
  • Monitoring: Document communication with members, family, physicians, and other healthcare providers to ensure members' progression in meeting established care plan goals.
  • Outcomes Management: Evaluate the extent to which established goals in the plan of care have been achieved.

Requirements:

  • Master's Degree, LICSW - Licensed Independent Clinical Social Worker or LCSW- Licensed Clinical Social Worker
  • 5 years of proven experience in a clinical social work role
  • LCSW- License Clinical Social Worker LICSW - Licensed Independent Clinical Social Worker or LCSW- Licensed Clinical Social Worker Upon Hire Required
  • CCM certification in Case Management (preferred)

What We Offer:

CareFirst BlueCross BlueShield offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity:

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.


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