SNP Social Worker-Peak

About the role

The SNP Social Worker will be an integral member of the health plan's medical management team. Reporting to SNP Care Management Operations leadership, this position assists the SNP Care Manager in coordinating benefits with MA and Medicaid and connecting members to community resources. The role is committed to improving the health status of members and the community.

Responsibilities

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Affirm compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
• Perform psychological, social, and economic care management interventions for members with severe/persistent mental or emotional disorders.
• Conduct telephonic behavioral health comprehensive assessments of members' environmental, behavioral, psychological, economic, and social factors.
• Develop and implement individualized and culturally sensitive care plans in collaboration with the member's assigned CM, addressing problems, interventions, barriers, and goals.
• Perform telephonic re-assessments, care plan revisions, and evaluate the effectiveness of the members' care plan.
• Participate in ICT meetings for members with SDOH and BH needs.
• Recognize early signs of decompensation requiring immediate case management intervention.
• Serve as an additional point of contact during transitions of care.
• Co-manage member cases with the CM to address psycho-social, economic, and cultural issues impacting care needs.
• Serve as a primary socio-economic resource for the D-SNP Care Management Team.
• Document members' cases accurately and timely to ensure coordination of their care needs.
• Adhere to all CMS, Code of Federal Regulations, local/state/national regulatory requirements, and guidelines as well as those outlined within the MOC.
• Collaborate with all members of the interdisciplinary care team to facilitate appropriate community resource assistance for members with identified needs.
• Serve as a primary socio-economic resource for the D-SNP Care Management Team.
• Collaborate for appropriate resource and financial management, including financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.

Qualifications

• Masters Degree in Social Work or related field.
• Current social worker licensure for the applicable service area.
• Two (2) years of clinical experience.
• LICSW certification in the state of West Virginia (preferred).
• Management of Medicare and/or Medicaid populations.
• Two (2) years of Behavioral Health experience.

Skills and Abilities

• Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.
• Excellent written and oral communication skills.
• Problem-solving capabilities to drive improved efficiencies and customer satisfaction.
• Attention to detail.
• Proficiency with Microsoft Office products.
• Ability to work under stressful working conditions.
• Meeting defined deadlines and deliverables is an imperative skill for this role.