Director of Social Work

About the Role

We believe all patients are entitled to the highest level of medical care. As the Director of Social Work, you will plan, organize, and direct Enterprise operations for outpatient Social Work and Behavioral Health within Care Management. This role coordinates duties with appropriate personnel to meet operational program needs, ensures compliance with state and federal health plan requirements, Medicare guidelines, and NCQA standards, and develops and implements policy and procedures. You will foster communication and teamwork between social worker teams, physicians, staff, market care management teams, corporate departments, vendors, and senior leadership. The position directs long-term planning for Social Work and Behavioral Health and acts as a resource to all internal and external customers, overseeing and evaluating all Care Management Social Work and Behavioral Health programs.

You will report to the Vice President of Care Management and assist senior leadership with long-term planning initiatives to maintain operations, ensuring activities align with the strategic direction and the mission and values of the company.

Responsibilities

• Accountable for end-to-end social work/behavioral health processes.
• Oversees social work functions and ensures compliance with approved guidelines, government-mandated regulations, and contractual agreements, including NCQA, URAC, and CMS.
• Manages a team of Licensed Social Work/Behavioral Health Managers, providing direction to ensure effective management and support of SW/BH staff.
• Develops functional, market-level, and/or site strategy, plans, production, and/or organizational priorities.
• Identifies and resolves technical, operational, and organizational problems outside their own team.
• Responsible for product, service, or process decisions likely to impact entire functions and/or customer accounts (internal or external).
• Provides leadership to and is accountable for the performance of managers and/or senior-level professional staff.
• Reviews and implements Social Work protocols for staff oversight and development.
• Leverages clinical acumen to provide guidance to staff and assists in navigating the medical management system.
• Provides oversight and review of coordination of care.
• Ensures employees are current with clinical licensure and certifications.
• Develops, oversees, and delivers operational or technical training.
• Fosters leadership skills for supervisor positions to ensure aligned management of staff, including the development of future leadership candidates.
• Plans, implements, and manages Social Work/Behavioral Health/Community Health Worker programs.
• Develops policies, procedures, and guidelines for programs.
• Reviews and approves policy and process changes.
• Evaluates regulatory changes and determines steps needed to implement them in the program.
• Identifies and implements business development opportunities to support program growth.
• Oversees and navigates technology applications utilized in the delivery of programs.
• Intervenes in the resolution of member or employee complaints or issues as necessary.
• Creates and implements a business continuity plan to minimize interruptions to the business.
• Promotes communication to members by informing them of updates and revisions in policies using training, orientation opportunities, newsletters, or other resources.
• Cultivates relationships with internal and external groups in support of member education and knowledge sharing.
• Ensures compliance of the Social Work Program and services.
• Interprets compliance, clinical, and medical reports.
• Evaluates compliance with Federal, State, and Local regulatory and organizational guidelines.
• Evaluates programs and services against accreditation standards and contractual requirements.
• Oversees ongoing monitoring and internal auditing against relevant guidelines and standards.
• Implements process improvement activities to address areas of non-compliance or ensure procedures are followed.
• Measures employee/provider performance against internal procedures and protocols.
• Ensures team members address gaps in performance against internal procedures and protocols.
• Monitors and evaluates employee performance and productivity.
• Develops operations program goals and communicates performance metrics and expectations.
• Directs data collection and measurement of outcomes.
• Applies metrics to evaluate services, employee performance, and program outcomes.
• Identifies causes of performance deficiencies and determines appropriate follow-up actions.
• Drives implementation of best practices and standards.
• Plans and manages operations to ensure financial viability.
• Develops operational budgets for medical and clinical operations.
• Evaluates staffing ratios, stratification of care, overtime, agency usage, or level of position to effectively manage labor expenses.
• Reads financial reports, identifies reasons for financial performance gaps, and identifies opportunities for improved financial performance and enhanced return on investment.
• Collects and reviews data to evaluate financial outcomes of programs and services.
• Conducts cost/benefit analysis on programs to drive efficiencies and identify opportunities to enhance financial viability.

Requirements

• Undergraduate degree in behavioral sciences; preferably a Bachelor's of Science in Social Work.
• 10+ years of experience in social work with a minimum of 5 years at a management level.
• Experience in contract language, claims, Utilization Management guidelines, and accreditation guidelines.
• Ability and willingness to travel both locally and non-locally as determined by business need (up to 30% of the time).

Preferred Qualifications

• Master's Degree or higher.
• Active and unrestricted LCSW license in any US state.
• Prior multi-site regional operations management responsibilities.
• Experience with managed care.

Physical & Mental Requirements

• Ability to sit for extended periods of time.
• Ability to stand for extended periods of time.
• Ability to receive and comprehend instructions verbally and/or in writing.
• Ability to use logical reasoning for simple and complex problem-solving.

Pay

The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).