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in Honolulu, HI

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Hours Full-time, Part-time
Location Honolulu, HI
Honolulu, Hawaii

About this job

In your field, learning never stops. And neither do you. You are continually pushing yourself to reach higher and go further. To do everything you can to ensure a positive outcome for our patients. Staying on top of your game and persevering in the face of challenge will be a big part of your success. And at every turn, you'll have the support of an elite and dynamic team. Join us in this role and you will use your diverse knowledge and experience to make health care work better for our patients, while doing your life's best work.(sm)


 


In this role, you will work in the field and coordinate care on behalf of patients who are receiving long-term care, along with home and community services. Your experience with hospital and long-term care facilities will be essential in relaying the pertinent information about the patient needs and advocating for the best possible care available. At times, your patience may be challenged. But in the end, your confidence, decisiveness and perseverance will help you positively impact our patient lives, and ensure more positive outcomes for all.


 


To get better insight to this role and determine if it is the right fit for you, click here to view the Realistic Job Preview:


 


Primary Responsibilities:



  • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care

  • Utilize both company and community-based resources to establish a safe and effective case management plan for members

  • Collaborate with patient, family, and healthcare providers to develop an individualized plan of care

  • Identify and initiate referrals for social service programs; including financial, psychosocial, community, and state supportive services

  • Manage care plan throughout the continuum of care as a single point of contact

  • Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members

  • Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team

  • Utilize approved clinical criteria to assess and determine appropriate level of care for members

  • Document all member assessments, care plan and referrals provided

  • Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care

  • Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan

  • Accountable to understand role and how it affects utilization management benchmarks and quality outcomes

 

Requirements

Required Qualifications:



  • Bachelors of Social Work

  • Current, unrestricted Social Worker license in the State of Hawaii (LSW, LCSW, LBSW)

  • 1+ years of experience working with Medicaid/Medicare populations, preferably in long term care or HCBS settings

  • 1+ years of clinical or service coordination experience applicable to the managed care population

  • Proficient in the use of a PC in a Windows environment, including MS Word

  • Reliable vehicle, current and unrestricted driver's license, and proof of auto insurance

 


Preferred Qualifications:



  • Experience in field-based case management

  • Experience in Utilization Management (acute and/or HCBS)

  • Master's in Social Work

 


Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


 


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


 


Job Keywords: Social Worker, LBSW, LCSW, LISW, Medical Social Worker, Case Manager, Care Coordinator, Field Service Coordinator, Ohana, Quest, Medicaid, Medicare, Honolulu, HI, Hawaii