Social Work Case Manager, South San Francisco, CA
SOCIAL WORK CASE MANAGER
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Social Work Case Manager. The Social Work Case Manager is accountable to provide crisis intervention, biopsychosocial assessment and complex discharge planning services for high ED utilizing HPSM members. Provides consultation related to psychosocial aspects of care as a member of the interdisciplinary treatment team. Serves as facilitator for community resource programs and is a liaison to HPSM and community referral agencies. This role is primarily housed at Mills Peninsula Hospital Emergency Department in Burlingame, CA.
The essential duties and responsibilities will include the following:
- Assist emergency department staff with assessing psychosocial needs of members and makes appropriate referrals to behavioral health and other community based services.
- Maximize opportunity to access services in least restrictive and non-institutionalized settings.
- Ensure that every identified member on the caseload has a plan of care before discharge from the ED.
- Mobilize services for members upon discharge from ED including but not limited to medications, provider visit follow up, connection to additional supports such as mental health and substance use disorder resources, authorizations for mental health services.
- Work collaboratively with hospital and treatment partners to evaluate and provide feedback to providers regarding coordination of covered services.
- Relay critical information back to utilization management team for prior authorization needs.
- Relay critical information back to inpatient, concurrent review team for management of members who get admitted inpatient from the ED.
- Use Motivational Interviewing techniques to identify patient/family strengths to be incorporated into brief problem solving interventions.
- Assess relationships between the patients/family environments to identify factors contributing to barriers to engagement with treatment or resources.
- Help decrease unnecessary emergency room visits by establishing care with PCPs, Specialists, and other community resources.
- Complete all required documentation and telephonic member follow-up within HPSM and/or Sutter computer systems within the required timeframes.
- Assist with triage of members in the ED to other provider supports such as Landmark.
- Coordinate with assigned community providers to alert them of member’s ED visit and individualized follow-up care plan.
- Participate in IDT/ICT meetings and clinical huddles.
- Follow-up with members who are discharged from the ED within 3 business days via phone. Determine if a community visit is needed to bridge services. Additional follow-ups for up to 30 days as needed.
- Identify opportunities for continuous process improvements.
- Assist in risk stratification of members who present to the Emergency Department.
- Monitor, track, and report on all work conducted.
- Perform other duties as assigned.
Education and Experience: Master's degree in Social Work, Psychology, Counseling or Marriage or Family Counseling or above required. Two (2) years of experience in mental health, substance abuse treatment or hospital/ED environment. Current unrestricted CA licensure as LCSW. Experience and training in motivational interviewing, trauma informed care, and harm reduction. Experience with San Mateo County social and behavioral health resources. Experience working in a managed care environment. Bilingual skills preferred.
Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, Electronic Medical Records systems, and PowerPoint. San Mateo County provider and community resources. Medicare and Medi-Cal coverage requirements and regulatory guidelines. Utilize Access, Microsoft Office programs; perform internet research. Managed Care processes, including use of Milliman Care guidelines or InterQual. Working knowledge of all relevant federal, state, local and regulatory requirements.
Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Be flexible and adapt to changing needs of Emergency Department environment. Adapt to changes in requirements/priorities for daily and specialized tasks. Establish and maintain effective interpersonal relationships with all levels of staff, other programs, agencies and the general public. Communicate effectively, both verbally and in writing, with individuals from varying cultural and ethnic backgrounds.
Compensation and Benefits
Starting Compensation Range: - Depending on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: email@example.com or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.
Submissions without a Cover Letter and Salary Expectations may not be considered.