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Hours Full-time, Part-time
Location Dallas, TX
Dallas, Texas

About this job


WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health.  WellMed's proactive approach focuses on prevention and the complete coordination of care for patients.  WellMed is now part of the Optum  division under the greater UnitedHealth Group umbrella.


 


Do you have compassion and a passion to help others?  Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)


 


The Social Worker for Care Management acts as a liaison for the members of WellMed, Transition Care managers, and ancillary care facilities through the continuum of care; encompassing in-patient episodes, post hospitalization and ongoing care as identified for high risk patients with multiple co-morbidities and/or psychosocial needs.  The primary scope is to advocate for patients and their families by providing referral, to community resources, financial assistance as requested with personal and environmental difficulties which predispose to illness. The Social Worker for Care Management will be expected to coordinate discharge planning needs related to community resources, financial assistance programs, and long term activity of daily living needs that are outside the benefit criteria of medical insurance coverage.  Assist in coordinating efforts to encourage maximum level of independence or our members. The Social Worker for Care Management will assist in the promotion of ethical responses to address the conflicting value positions held by various parties involved in health care settings and can assist in developing consensus as a member of a multi-disciplinary approach to patient care.


 


Primary Responsibilities:



  • Coordinates inpatient and outpatient services, not limited to: discharge planning, needs related to community resources, financial assistance programs and long-term activities of daily living needs outside the benefit criteria of the medical insurance coverage in acute and ancillary care facilities in order to facilitate a safe quality discharge. This includes members that require complex custodial, long-term placement

  • Performs member evaluations/onsite visits in multiple settings, including but not limited to: member's home, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of plan of care

  • Identifies and assists with patients with high-risk diagnoses and/or patients with multiple co-morbidities who will benefit from social care coordination, contracts, providers and facilities

  • Demonstrates thorough knowledge of alternatives of care such as palliative care, referrals for support systems and care directives for care givers: to include but not limited to Directives to Physicians, Out of Hospital, Do Not Resuscitate, and Guardianship Applications

  • Enters timely and accurate data into proprietary databases as needed to communicate patient needs.  Manages assigned case load in an efficient and effective manner

  • Manages total work process and provides constructive information to minimize problems and increase internal and external customer satisfaction

  • Participates in the development of appropriate QI processes, establishing and monitoring indicators.  Take corrective action when data shows a need to modify management strategies or systems

  • Assists the Care Management Manager to formulate activity reports related to utilization of community resources and custodial placement by members

  • Demonstrates the ability to report Quality of Care issues to management and potentially to health plan per compliance guidelines under the supervision of team supervisor

  • Attends and contributes to staff meetings

  • Seeks ways to improve job efficiency and make suggestions to the appropriate manager

  • Performs all duties for internal and external customers in a professional and responsible manner

  • Demonstrates flexibility with ongoing assignments

  • Respects customer and organizational confidentiality

  • Assists in the growth and development of self and associates by sharing special knowledge with others

  • Attends educational offerings to keep abreast of change and comply with licensing requirements

  • Maintains knowledge of the Health Plan Benefits, quality of care criteria of health plan as well as compliance with established and all new or revised WellMed Policies and procedures when posted or distributed

  • Strives to personally expand working knowledge of all aspects of WellMed departments; attends and contributes to clinic meetings

  • Performs all other duties as assigned

Requirements


Required Qualifications:




  • Current social worker's license in the state of Texas

  • Bacehlor's Degree in Social Work

  • 3 or more years related social work

  • Planning, organizing, conflict resolution, negotiating and interpersonal skills

  • Independent problem identification/resolution and decision making skills

  • Sound knowledge of managed care, medical terminology, referral process, claims

  • Excellent verbal and written skills

  • Ability to interact productively with individuals and with multidisciplinary teams

  • Knowledge of legal and ethical issues related to patients' rights

  • Knowledge of community support services and funding

  • Experience working with geriatric and psychiatric patient populations

Preferred Qualifications:



  • 5+ years of social work related experience

  • Knowledge of disease management, managed care, medical terminology, referral process, claims, and ICD-9

  • Experience working with geriatric and psychiatric patient populations

  • Bilingual (English/Spanish) language proficiency

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.


 


Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.


 


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM




Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


 


Job Keywords: BSW, MSW, Social Worker, Dallas, TX