Bilingual Spanish Social Worker, Care Management (Riverside)

About the role

This is a field/remote role in Riverside, CA & surrounding areas.

Responsibilities

• Support high-risk members by providing person-centered interventions to address serious mental illness, substance use disorder, and behavioral barriers to care.
• Collaborate with the care team to assess, develop, and implement care plans while addressing health, behavior, and psychosocial needs through telephonic, virtual, or in-person visits.
• Conduct comprehensive assessments to identify chronic conditions and psychosocial challenges affecting independent living, preventing unnecessary healthcare events, including ER visits and hospital admissions.
• Manage and provide targeted support for members with serious mental illness, substance use disorder, and behavioral barriers to care, including those identified as high-risk, ensuring comprehensive care and appropriate interventions.
• Evaluate assessment findings against evidence-based guidelines, clinical reasoning, and best practices to ensure the clinical appropriateness of member-centered care plans.
• Develop and integrate clinical insights and community standards to create comprehensive and effective care strategies.
• Provide education and coaching surrounding behavioral and mental health treatment, interventions, and pharmacological approaches.
• Work with members in the prevention of illness, promotion of health, and management of chronic health problems.
• Collaborate with internal and external providers, specifically with Behavioral Health/Mental Health vendors and programs.
• Serve as the key point of contact for complex behavioral health cases to assist with care coordination and act as Subject Matter Expert (SME).
• Exhibit comprehensive member engagement and patient activation skills with the ability to communicate complex medical and behavioral health interventions cohesively with overall plan of care.
• Participate in interdisciplinary planning and case conference meetings to ensure person-centered care and support member’s discharge from an inpatient or institutional setting.
• Build strong working relationships with the Medical Groups, vendors, and community organizations.
• Utilize department desktop procedures, workflows, job aids, and training materials.
• Identify barriers to work processes and bring them to the attention of the supervisor/manager.
• Adhere to all quality, compliance, and regulatory standards.

Qualifications

• Graduate or Advanced Degree required in Social Work.
• Licensed Clinical Social Worker; CCM preferred.
• 3-5 years managed care, healthcare environment, or mental health case management.
• 2+ years working with seniors and working remotely strongly preferred.
• Technical expertise - Advanced analytical skills.
• Problem Solving - Basic problem-solving skills.
• Communication - Good communication and interpersonal skills.
• Spanish speakers are strongly preferred.
• Strong interpersonal skills, including excellent written and verbal communication skills.
• Strong organizational skills.
• Strong critical thinking skills.
• Ability to collaborate effectively with a multidisciplinary team.
• Ability to appropriately maintain confidentiality.
• Ability to communicate complex medical information with simplicity and kindness and build strong rapport.
• General understanding of NCQA standards, CMS and DHCS regulations.
• Bilingual - Must be bilingual in English/Spanish. (Test will be administered to assess proficiency.)

Benefits

• Annual employee bonus program.
• Robust Wellness Program.
• Generous paid-time-off (PTO).
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
• Adequate 401(k) Retirement Saving Plan with employer match and contribution.
• Robust employee recognition program.
• Tuition reimbursement.

Pay

Base salary range: $38.61 to $53.20 per hour.

Schedule

Field/Remote