Description: Job Profile Summary
Position Purpose:
Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
Education/Experience:
Requires a Bachelor s degree and 2 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:
Current state s clinical license preferred
For Illinois YouthCare Plan only: Education/Experience: Bachelor's degree in Social Work, Nursing, Health Behavioral Science or equivalent experience. 2+ years of experience working within a social service agency and/or advocacy environment. Must reside in Illinois.
For Illinois YouthCare Plan Foster Care Liaison Roles only: Will be stationed on-site and hosted by DCFS Regional Offices throughout the State to provide administrative coordination with DCFS staff and stakeholders. Will be available during regular work hours to communicate with and to provide education and training to DCFS staff and stakeholders regarding managed care, and to engage in immediate problem resolution with Contractor's administrative staff. Will ensure that issues or barriers reported to a liaison must be addressed and the resolution communicated to appropriate DCFS staff or stakeholder.
For Health Net Federal Services only: Licensed Bachelor's or Master's Prepared Social Worker; LSW, LCSW, LICSW, or LMSW required
For Nevada SilverSummit (Medicaid) Healthplan: Licensed Bachelor's or Master's Prepared Social Worker: LSW or LMSW required.
For Mississippi Magnolia Health plan: Bachelor s or Master s degree in a healthcare related field (social work, sociology, psychology, public health) and 2 4 years of related experience; LSW,LMSW preferred.
For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel. required
Responsibilities:
Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform on-site visits to assess member s needs and collaborate with providers or resources, as appropriate
May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
Performs other duties as assigned.
Complies with all policies and standards.
Custom Fields:
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: 184611
Name: Field Worker
Value: No
Name: Which Health Plan, programs or functions will this work support?
Value: Peach State Health Plan
Name: Shortlisting Date
Value: None