Position Summary
As a field Social Worker, you will play a vital role in the member-centered care planning process alongside the other core care team members. Your responsibilities will include:

• Conducting field visits to the member’s home, community locations, medical facilities, and other locations.

• Completing care management focused assessments.

• Setting member-centered goals.

• Identifying barriers and strategies to address them.

• Establishing, monitoring, and adapting interventions to achieve member goals.

Fundamental Components

• Focus on enhancing quality of care, ensuring compliance, improving outcomes, and reducing costs.

• Develop and implement strategies to coordinate and integrate post-acute and long-term care services, preventing exacerbations and unnecessary custodial placements.

• Perform initial and ongoing assessments for members enrolled in the Long-Term Care Program and other care initiatives.

• Utilize social work principles and strategies to address the social determinants of health within each member’s individualized care plan.

• Collaborate and facilitate ongoing communication with providers, primary care physicians, Medical Directors, pharmacists, and care management staff to discuss member status and progress toward goals.

• Advocate for members to ensure they receive all necessary care covered by their benefit plans and available through Medicaid and community resources.

• Build relationships with hospital social workers and community resources, leveraging data to ensure effective management of catastrophic, acute, and chronically ill members, aiming for appropriate utilization and reduced lengths of stay.

• Assist in identifying and reporting potential quality improvement opportunities.

• Direct social work interventions, including psychosocial assessments, follow-ups, in-home or facility assessments, documentation of issues and interventions, and facilitating access to a continuum of care through appropriate referrals.

Required Qualifications

• Candidate must reside in one of the following counties: Granville, Orange, Chatham, Harnett, Johnston, Wilson, Nash, and Franklin, Wake, Durham, North Carolina (NC)

• 2+ years of experience in medical social work or case management

• Candidate licensure must comply with requirements in the state where job duties are performed

• Ability to travel within a designated geographic area for in-person case management activities (Travel expenses are reimbursed in accordance with the company travel reimbursement policy)

• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Social Worker role

• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually

• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

Education

• Bachelor of Social Work Degree (REQUIRED)

• Master of Social Work (PREFERRED)

License

• Candidate licensure must comply with requirements in the state where job duties are performed