Social Worker Disease Mgmt

About the role

Provides Disease Management (DM) services to TRICARE beneficiaries. The Social Worker – Disease Management collaborates with the clinical team to consult and collaboratively support the assessment, planning, implementation, coordination, monitoring and evaluation the beneficiary’s health and psychosocial needs with a focus on empowering the beneficiary to successfully manage their medical, behavioral and psychosocial needs related to their chronic condition.

Responsibilities

• Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiary’s overall goals of care.
• Collaborate with the clinical team to contribute to the whole-person plan of care by incorporating behavioral and psychosocial assessment findings utilizing evidence-based guidelines, clinical reasoning and clinical practice guidelines.
• Provide education and coaching support specific to the beneficiary’s behavioral and psychosocial needs to prevent to support management of their chronic condition.
• Manage activities necessary to ensure appropriate utilization and access to medical and behavioral resources, while maintaining optimal standards of care.
• Review, identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
• Participate in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
• Assess high risk factors, acuity and need for other TRICARE services and resources.
• Facilitate transfer of beneficiary between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.
• Adhere to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.

Requirements

• Current, unrestricted SW licensure to independently work within scope of practice within state of residence (BSW)
• U.S. Citizenship
• Minimum of two years’ experience in case management, care coordination or discharge planning in an acute, ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO)
• Preferred Care or Disease Management experience with a managed care organization (MCO)
• Master’s degree in Social Work MSW; LCSW, LMSW
• Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid

Qualifications

• Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid
• Knowledge of TRICARE programs and benefits, managed care concepts, and URAC DM program standards
• Case management interventions, crisis intervention strategies, collaboration skills, legal and regulatory requirements, and HIPAA privacy regulations
• Thorough knowledge of Case Management, Utilization Management, HIPAA Privacy and Security regulations

Skills

• Communication / People Skills
• Computer Literacy
• Coping / Flexibility
• Copied / Flexibility
• Empathy / Customer Service
• Independent Thinking / Self-Initiative
• Multi-Tasking / Time Management
• Organizational Skills
• Problem Solving / Analysis
• Team-Building / Team Player

Benefits

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success.