- Care Management documentation is completed on the specific departmental platform/system. Confirm member/enrollee eligibility and available benefits. Participates in the preparation and on-site reviews (NCQA, OSR and DHCF as appropriate). Responsible for completion of documentation review and peer to peer audit as assigned by management. Responsible for adherence to the departmental SOPs, NCQA Complex Care Management Standards and Health Plan Standards. Adheres to the CMSA Standards of Practice for Case Management. Maintains confidentiality of patient information according to HIPAA and departmental policies. Other duties as assigned by management. Other duties as assigned per divisional requirements and needs of the members/enrollees.
- Licensed Independent Clinical Social Worker or LCSW
- Licensed Clinical Social WorkerExperience: 5 years Proven experience in a clinical social work role.
- MCG Chronic Care Guidelines:
- Licensed Independent Clinical Social Worker or LCSW
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Social Worker - Baltimore, United States - CareFirst BlueCross BlueShield
Description
Resp & Qualifications*PURPOSE:
The Social Worker (SW) may support the Care Managers, Supervisors, Manager, and Director of Care Management for the FEP Population. They are to ensure available resources are being used in a timely and cost-effective manner to obtain optimum value for both the member/enrollee and the reimbursement source. The SW will adhere to the principle of the Quadruple Aim improving member/enrollee experience, improved clinical outcomes, lower costs while pursuing health equities for our members/enrollees and retaining staff.
The SW will be fully engaged in the team direction, address problems and provide guidance to members of the team to meet established performance metrics and performance guarantees.
The SW is part of an effective, efficient workforce to support all aspects of the FEP Care Management department across the continuum of care settings, clinical programs, and services for members/enrollees.
This includes the planning, implementation, and refinement of Care Management services, interventions and initiatives that support departmental and divisional goals.
The role works closely with the Care Management Coordinator, Care Manager, Supervisor, and Manager to develop and operationalize sustainable processes to support functional improvements for the organization.
NOTE:
We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
ESSENTIAL FUNCTIONS:
+ Care Management Process:
The SW may be tasked with episodic interventions involving the domains of social determinants of health such as housing, food insecurities, economic stability, education quality and access, neighborhood and environmental.
The SW will be available to assist and lead interventions in crisis situations suicide attempts, acute domestic violence events such as assisting with safe passage to shelters/ER as needed.
The SW may assist with transportation benefits as needed. The SW will also assist in referring to mental health providers and/or facilities as needed.QUALIFICATIONS:
Education Level:
Master's Degree in LICSW
+ Knowledge of patient rights and laws relative to those rights, such as HIPAA.+ Ability to remain patient and calm in stressful situations.+ Excellent communication skills both written and verbal.+ Ability to build comprehensive reports and effectively convey information to others.+ Knowledgeable of federal/state mandates as they apply to various plan contracts.+ Knowledgeable of federal/state mandates as they apply to various plan contracts.
Licenses/Certifications
:
LCSW- License Clinical Social Worker LICSW
Salary Range:
$63,360 - $125,840
Travel Requirements:
Occasionally
Estimate Amount:
Varies
Salary Range DisclaimerThe disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed.
This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration.
It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.
In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
DepartmentPPO Care ManagementEqual 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.
Where To ApplyPlease visit our website to apply:
Federal Disc/Physical Demand
Note:
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.Sponsorship in US**Must be eligible to work in the U.S. without Sponsorship.
\#LI-SS1REQNUMBER:
19730
