Clinical Support Team Social Worker

Description and Requirements

The Social Worker is responsible for assessing members' goals, cultural preferences, strengths, informal supports and social determinants of health needs. The incumbent partners with a Care Management team and helps members achieve an optimal level of independent functioning and sustain their mental and social health. The Social Worker also provides consultation and education to enrolled members, family/caregivers, and other people responsible for the member's shared care.

Duties and Responsibilities:

• Completes assessment for each member related to their receipt of community based long-term care services.
• Develops a comprehensive care plan for each member based on assessments, counseling, environment, social support and financial status.
• Acts as a member advocate and liaison with various governmental and private agencies such as Medicaid, Medicare, and Social Security to maximize network of support and secure needed services.
• Provides education, referrals, and support to members and their families as needed.
• Keeps up to date on federal (Medicare) and state (Medicaid) regulations.
• Interacts with community mental health providers, hospitals, nursing facilities, community services, family/caregiver, and other agencies as needed.
• Collaborates with each Clinical Operations' core area as needed
• When needed, may provide authorization and ensure close oversight and appropriateness of service utilization including but not limited to social work home visits, Personal Emergency Response System (PERS) adult day programs, social day programs, home delivered meals, and heavy-duty cleaning.
• Additional duties as assigned.

• Fluent in Spanish
• PHI electronic shared network database and archival system experience.
• Thorough knowledge of current community health practices for the frail adult population and cognitive impaired seniors.
• Work experience as an LMSW or LCSW including experience in one or more of the following areas; geriatrics, discharge planning, case management, assessments, acute, sub-acute, long-term care (LTC), health insurance, and/or home care environment
• Intermediate Outlook, Word, Excel, PowerPoint, and Adobe Acrobat skills.
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Ability to handle rapidly changing crisis situations.
• Demonstrated professional writing, electronic documentation, interpersonal, and assessment skills