Social Worker, LSW, Healthcare, WellMed - Corpus Christi, TX

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; mhis 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 careIdentifies 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

Required Qualifications:

Bachelor’s degree in Social Work (BSW)
Current social worker’s license in the state of Texas
Three or more years of social work related experience
Must have sound knowledge of managed care, medical terminology, referral process, claims
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:

Posses planning, organizing, conflict resolution, negotiating and interpersonal skills
Independent problem identification / resolution and decision making skills
Excellent verbal and written skills
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
 
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease.
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and 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: WellMed, Healthcare, Bilingual, Social Worker, SW, LSW, LMSW, Advocate, Staples Street, Corpus Christi, Kingsville, Alice, Ingleside, Robstown, Port Aransas, Bishop, Rockport, Aransas Pass, Texas, TX