Social Worker- Full Time/Day Shift
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Remote role but must be able to pick up and drop off equipment in Newark, NJ Responsible for performing care coordination duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care for specialty populations. o Implement the delivery of high quality, cost-effective care based on a customized population model of care supported by clinical practice guidelines established by the plan. Advocate for the member among various sites to coordinate resource utilization. o Utilize the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status. o Ensure care for mandated non-compliant members through the monitoring of utilization. o Document accurately and comprehensively based on the standards of practice and current organization policies. o Evaluate care by problem solving, analyzing variances, and participating in quality improvement to enhance member outcomes. o Monitor member's care activities, regardless of the site of service or network participation, and outcomes for appropriateness and effectiveness. o Graduate level degree in Social Work or Health and Behavioral Science preferred. o Requires a minimum of two (2+) years' experience serving members with special needs.
o Requires strong knowledge of managed care principles. o Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
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