Coordinates the socio economic needs and service of selected member populations across the continuum of illness. Coordinates and plans activities and behavioral routines to meet the medical, social and emotional needs of members and their families. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care. Collaborates with the interdisciplinary team to achieve optimal resource outcomes.
Interviews clients and their families and coordinates programs and activities to meet their social and emotional needs.
Provides support to care and case managers regarding the coordination of care plans for members by utilizing social service expertise to evaluate the members need for alternative services and third party intervention.
Outreaches to members telephonically and/or in-person to provide health coaching and consultation and by providing guidance regarding barriers to managing health conditions.
Assists members to change behaviors and to locate and access interpersonal, family and community resources that will make it easier to manage their health. Reviews benefits options, researches community resources, coordinates services, trains behavioral routines and enables members to be active participants in their own healthcare.
Provides telephone follow-up to ensure members have seen their PCP and are completing their treatment plan or preventive care services a defined by the PCP or guidelines.
Coordinates community resources with emphasis on the development of natural support system. Coordinates benefits, regulations, laws and public entitlement programs.
Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
Performs other duties as assigned.
In Hawaii, incumbents engaged in the Community Care Services program may conduct comprehensive member psychosocial assessments and develop a care management treatment plan specific to each member with high level acuity needs. Licensed clinical staff will review, direct needed changes and sign agreement with the service plan for each member.
Required A Bachelor's Degree in Social Work (BSW), Psychology, Counseling, Rehabilitation, or other relevant field
Required 2 years of experience in a health care environment with client care coordination responsibilities via assisting clients to change behaviors and to locate and access interpersonal, family and community resources that will make it easier to manage their health
Preferred Other Experience in a managed care environment
Intermediate Ability to work independently
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to create, review and interpret treatment plans
Intermediate Ability to multi-task
Intermediate Ability to work within tight timeframes and meet strict deadlines
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Demonstrated problem solving skills
Intermediate Demonstrated written communication skills
Intermediate Demonstrated time management and priority setting skills
Intermediate Knowledge of healthcare delivery
Intermediate Knowledge of community, state and federal laws and resources
Licenses and Certifications: A license in one of the following is required:
Preferred Licensed Bachelor Social Worker (LBSW)
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Other Knowledge of or the ability to learn company approved software such as EMMA, CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties.
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.