Jan 25, 2020
WellCare Health Plans
Coordinates the socio economic needs and service of selected member populations across the continuum of illness. Interviews, coordinates and plans daily living 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. Essential Functions: Interviews clients and their families and coordinates programs and activities to meet their social and emotional needs. Participates in and supports developed care plans for members and evaluates the members need for alternative services and third party needs. Outreaches to members telephonically and/or in-person to provide health coaching and consultation and by providing guidance regarding barriers to managing health conditions. Interacts continuously with members, family, physicians and other resources to determine appropriate action needed to address/support medical needs. Reviews benefit options, researched community resources, coordinates services, trains and creates activities of daily living 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. Helps establish process improvements leading to best practice and assist in implementing change movement. Trains, mentors and provides guidance to new and current Social Workers regarding policy and procedure, systemic tools, workload and care plan development. Performs other duties as assigned. Additional Responsibilities: In Illinois, the incumbent may conduct comprehensive member psychosocial/health assessments and develop a care management treatment plan to each member. Reports to: Supervisor, Non Clinical Care Management Department: MER - IL - Case MGMT Location: 1 Campus Martius #700, Detroit, MI 48226 Level: L10 Candidate Education: Required A Bachelor's Degree in Human services or other related field Required or equivalent work experience in a similar capacity in a managed care environment. Candidate Experience: Required 4 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 Required 2 years of experience in a managed care environment Candidate Skills: 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) Technical Skills: 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. Languages: 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.
Professional Diversity Network
Detroit, MI, USA