Case Manager/Service Coordinator LMSW – STAR Kids – Health Plan

Category : Healthcare
Location/City : TX - Houston
Id : 30421

We are searching for a Service Coordinator Advanced Social Worker - someone who works well in a fast-paced hospital setting. In this position, you'll function as a member of the interdisciplinary healthcare team in the provision of Level I (and higher) patient care with the underlying objectives of enhancing the quality of clinical and financial outcomes and patient satisfaction while managing the plan of care. You'll also pro-actively communicate with members of the healthcare team to ensure appropriate medical necessity for patients in beds and communicate with Payers and patient/family/healthcare team regarding payer information as necessary. Additionally, you'll ensure that care moves through the episode of care in a timely and efficient manner. Think you've got what it takes?
Responsibilities:
  • Completes a comprehensive problem identification analysis of Level I (and higher) patients to identify opportunities for intervention that are appropriate and realistic for the patient/family's psycho-social, cultural, spiritual, and physical plan of care
  • Conduct holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information by interviewing Member/family and performing careful evaluation of psychosocial, environmental, cultural, health access and medical variables
  • Identifies actual and potential problems in services and treatments and discusses with the multidisciplinary team to identify solutions to barriers
  • Coordinates, facilitates and monitors the plan of care for Level I (and higher) patients throughout the episode and continuum of care to achieve the optimal clinical and financial outcomes
  • Oversees discharge planning and facilitates safe transitions to community settings
  • Plans and executes interdisciplinary and patient/family conferences as necessary to formulate and communicate the plan of care
  • Serves as a liaison between members of the interdisciplinary care team, community providers, payer sources, and patient/family to ensure safe and effective plans and smooth transitions between internal and external levels of care
  • Maintains professional relationship with payer representatives and assists in resolving any utilization issues that arise
  • Advocates for Member's care needs within the healthcare delivery system and associated services
  • Effectively and efficiently oversees the plan of care to optimally assure clinical and financial outcomes
  • Assures timely performance of utilization management processes to maintain compliance with Federal, State, and Managed Care contract regulations
  • Within the social work scope of practice, the care manager continuously assesses self-knowledge and competencies to assure job performance
  • Maintains current education and training to adeptly identify the Member's physical, behavioral, functional, and psychosocial needs

Qualifications:
  • Master's Degree in Social Work
  • Licensed Master Social Worker (LMSW) issued by the Texas Board of Social Work Examiners or Licensed Clinical Social Worker (LCSW) issued by the Texas Board of Social Work Examiners
  • Three (3) years of social work experience
  • Preferred experience in pediatrics working with children with special healthcare needs or working with a special needs population
  • Certified Case Manager (CCM), certificate of completion of Adult and Pediatric Integrated Case Management preferred
  • Certified Advanced Social Worker Case Manager (C-ASWCM) issued by the National Association of Social Workers preferred


EOE-M/F/V/D
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