PT 20 hours Case Manager Continuing Care Social Work (Bilingual)

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• Plans, develops, assesses and evaluates care provided to members.
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• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans.
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• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
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• Makes assessments of physiological and or functional status utilizing protocols.
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• Initiates appropriate diagnostic testing/screening and interventions.
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• Develops individualized patient/family education plan focused on self-management; delivers patient/family education specific to a disease state.
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• Implements strategies to target/assess risk factors and achieve and ensure patient follow-up according to clinical and strategic measures/outcomes.
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• Produces population based reports on outcomes specific to defined patient populations.
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• Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes.
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• Develops and maintains case management policies and procedures.
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• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
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• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
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• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
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• Arranges and monitors follow-up appointments.
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• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
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• Makes referrals to appropriate community services and outside providers.
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• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
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• Develops and collects data; trends utilization of health care resources.
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• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
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• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
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• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
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• Coordinates repatriation of patients and monitors their quality of care.
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• Graduate of an academic institution accredited by the Council on Social Work Education and a Masters degree in Social Work.

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• Demonstrated knowledge of case management, discharge planning, transfer coordination; TJC and other federal/state/local regulations.
• Must be able to work in a Labor/Management Partnership environment.
• Bilingual (English/Spanish) Level II required.

• Minimum two (2) years of case management experience with the population to be case managed preferred.
• Current and valid LCSW highly preferred.

Notes:

• Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.