Coventry Health Care is currently seeking a Social Worker for our newly developed enhanced case management program that focuses on high risk co-morbid Medicaid ABD members. The ideal candidate will have experience working with the senior population. The Social Worker position will work from home in Kentucky's Region 4 (Bowling Green, Somerset or similar area).
- Performs initial and periodic assessments of the members enrolled in the Co-Morbid Case Management program. Case management activities will focus on quality of care; compliance; outcomes and decreasing costs.
- Directs social work interventions including performing psychosocial assessment(s); telephone follow-up and facility assessments as indicated; documentation of problems; assessments; and/or interventions; and promoting ease of access to a continuum of care through appropriate information and referral.
- Proactive management with the objective of improving quality outcomes and decreasing costs.
- Applies case management concepts; principles and strategies in the development of an individualized case plan for enrolled members in case management that are at risk of poor outcomes. The case plan process includes assessment; goal setting; establishing interventions related to goals; monitoring success of the interventions; evaluating the success of the overall case plan and reporting outcomes and addresses the member's broad spectrum of needs.
- Conducts regular discussions as part of a multidisciplinary team and communicates updates with providers; the primary care physicians; health plan Medical Directors; pharmacists; and health services staff regarding the status of particular patients.
- Serves as a member advocate to ensure the member receives all of the necessary care allowed under the member?s benefit plan.
- Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits.
- Utilizes community resource expertise and alternate funding arrangements available to plan members when services are not available under the benefits program.
- Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay; and preventing avoidable Emergency Department utilization.
- Develops relationships with hospital social workers and community resources to assure appropriate case management of catastrophic; acute; and chronically ill members.
- Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the Quality Improvement Department.
- Indirect services will include meeting federal; state; and NCQA/URAC regulations to assure quality service; working cooperatively with and training other members of the UM team; providing social work consultation to healthcare professionals and members; maintaining an information base of referrals; submitting reports of services provided as directed by department policy; functioning as a liaison person with appropriate community agencies; and determining and implementing policies and procedures with respect to the delivery of social service functions.
- Maintains confidentiality of member information in accordance with HIPPA .
- Masters in Social Work required; state licensure preferred.
- Complies with all state requirements in the state where job duties are performed
- Minimum (2 years) experience in medical social work or case management; a thorough knowledge of casework and group work principles; practices; and methodology and extensive knowledge of community resources.
- Considerable knowledge of individual and group behavior and inter-relationships among social; economic; psychological; and physical factors; regulations; standards; and policies which relate to social work practice.
--Experience working with behavioral and mental health diagnoses
- Regular local travel will be required.
- Strong typing and computer skills (e.g. Excel; Word; Custom Programs; etc...)
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer; and we are committed to building a talented and diverse team.
Primary Location: , KY, US
Other Locations: Bowling Green-Kentucky-United States,
Organization: 10900 - CMS - STAR Corporate
Job Posting: 2013-01-02 00:00:00.0
Job ID: 1310003
Coventry Health Care - 15 months ago
In May of 2013, Coventry became a part of Aetna. We are excited to join together with common values and a common mission: empowering people...