Social Worker – Utilization Management Team

Psychosocial & Behavioral Health Support

Candidate should reside in Austin.

• Conduct psychosocial assessments for HHIC (Harbor Health Insurance Company) members identified through UM reviews who may have behavioral health, mental health, substance use, or complex social needs.
• Identify psychosocial barriers that may affect treatment adherence, recovery, or access to services.
• Provide support and care coordination for members experiencing behavioral health or substance use challenges.
• Collaborate with behavioral health providers, substance use treatment providers, and primary care teams to support appropriate care.
• Assist in identifying appropriate levels of care and support services for members when needed.

Social Determinants of Health (SDOH) Support

• Assess members for social needs such as housing instability, food insecurity, transportation barriers, financial hardship, and other social factors affecting health.
• Connect members to community resources, social service programs, and support services.
• Cook up referrals to community organizations, social service agencies, and recovery support programs as appropriate.
• Support members in navigating healthcare and community systems to access needed services.

Care Coordination & UM Team Collaboration

• Collaborate with UM nurses, the HHMG (Harbor Health Medical Group) Acute & Complex Care Team (ACT) team, and other resources, including pharmacy, to ensure comprehensive, holistic care for members.
• Participate in case reviews and care planning discussions for members with complex needs.
• Aid in member outreach, engagement, and education regarding available services and resources.
• Engage in face-to-face interactions with providers and members to assess and support social work–related member needs.
• Support efforts to improve care coordination and address barriers that may impact healthcare utilization.

Documentation & Compliance

• Maintain timely and accurate documentation in applicable UM and Care Management (CM) e.g. PA Tracker Google Sheet, Athena EHR, etc. systems.
• Ensure compliance with organizational policies, regulatory requirements, and privacy standards.
• Track and report activities related to psychosocial interventions and community resource referrals as required.

Required Qualifications

• Active Social Work license (LMSW)
• At least five years experience working with individuals experiencing behavioral health, substance use, or complex social needs.
• Reside in the Austin area and have knowledge of Austin-area community resources and social service systems.
• Strong communication, assessment, and care coordination skills.
• Ability to support occasional in-person interactions with providers and members in the Austin area.

PREFERRED QUALIFICATIONS

• Experience in managed care, health plans, or utilization management.
• Familiarity with Social Determinants of Health (SDOH) screening and interventions.
• Experience working with diverse or high-risk populations.
• Knowledge of Texas social service programs for members in need both local and state-wide preferred
• Familiarity with NCQA processes and requirements

Key Competencies

• Member-centered and trauma-informed approach
• Behavioral health and substance use awareness
• Resource navigation and community engagement
• Interdisciplinary collaboration
• Cultural competency
• Problem solving and advocacy
• Motivational interviewing and effective communication – building trust and encouraging member engagement
• Relationship-building and rapport development – establishing supportive, lasting connections
• Empowerment and self-advocacy support – guiding members to make informed decisions about their care