Job Details
Job Location
Main Office - Santa Barbara, CA
Position Type
Full Time
Education Level
Master's Degree
Travel Percentage
None
Job Category
Medical Management
Description
California Annual Salary Range: $82,165 - $119,140
Job Summary
This position reports to the Care Coordination Supervisor or designee. The Care Coordination Social Worker II (CCSW II) works closely with CenCal Health's (CCH) Health Services team and directly with members to assist with psychological and social care coordination needs. The master's prepared CCSW II addresses not only the psychosocial needs of members but also members' linkage and eligibility to government programs, social services, and community resources. The CCSW II responsibilities include but are not limited to communicating with members, providers, and community-based organizations; assisting members with complex medical and psychosocial needs with the transition of care and housing resources; referring to funding sources; and identifying community resources to maintain members in the least restrictive environment. The CCSW II must have extensive psychosocial knowledge to manage a caseload that includes members of any age enrolled in any Health Services Clinical Programs, such as Case Management, Care Coordination, Pediatric-Whole Child Model, Disease Management, and Behavioral Health.
Duties and Responsibilities

• Perform member-centered assessments/reassessments.
• Develop individualized care plans that are member-centric and address psychosocial, rehabilitation, and environmental concerns.
• Conduct follow-up contacts with members and providers; monitor member's needs and care plan; identify and develop a support system with the member.
• Collaborate with multidisciplinary team members within the Health Services department and CenCal Health.
• Based on needs identified in an assessment, facilitate, coordinate, and monitor services from different providers and community resources that serve the member
• As assigned, assist members and their families in the California Children's Services-Whole Child Model Program (CCS/WCM) with transition care planning from age 16 until 21 when members age out of CCS.
• As assigned, assist members in the Disease Management Program with psychosocial needs.
• As assigned, assist with placement in alternative living arrangements, such as SNF, board and care, shelter, etc.
• Assess the member as a total person and identify the functional limitations that impede independent living.
• Provide resources and linkages to crisis management.
• Collaborate and consult with CCH Nurse Coordinators and Medical Directors on medical issues as necessary.
• Refer members to specialized programs, such as TCRC, County MH, and Public Health.
• Consult and cooperate with community systems to facilitate linkage, referral, advocacy, and follow-up, focusing on attaining care plan goals.
• As necessary, perform home visits to ascertain the home situation.
• Maintain an active caseload of adult and pediatric members and provide necessary interventions within areas of expertise and limits.
• Adhere to mandated reporting requirements.
• Maintain high ethical conduct and adhere to HIPAA and confidentiality regulations.
• Participate in continuing education activities and have current knowledge in area(s) of expertise.
• Participate in CCS Medical Therapy Unit conferences and address identified psycho-social issues of members and their families.
• Other duties as assigned.

Qualifications
Knowledge/Skills/Abilities
Required:

• Demonstrate expertise and ability to function as a care manager, as evidenced by my experience and proficiency in work responsibilities.
• Ability to communicate and negotiate with members and families, physicians, and other health care providers clearly and effectively.
• Be self-motivated and seek knowledge to improve personal and professional performance.
• Able to work effectively in a cross-functional team environment.
• Demonstrate extensive knowledge of social resources within CenCal Health's coverage area.
• Demonstrate extensive psychosocial knowledge in managing members enrolled in Health Services Clinical Programs, such as Case Management, Care Coordination, Pediatric-Whole Child Model, Disease Management, and Behavioral Health.
• Have strong computer literacy and skills.
• Excellent verbal communication and writing skills are required.
• Knowledge of existing community resources and ability to effectively link members to agencies.

Preferred

• Knowledge of managed care issues (including benefits and contract limitations, delivery, and reimbursement systems), and the role of medical management activities
• Knowledge of State and Local social service agencies and community-based organizations
• Current crisis prevention/intervention certification
• Knowledge and skills in community-based behavioral health care resources.
• Knowledge of the unique medical and psycho-social problems of children and young adults with disabilities and special healthcare needs
• Bilingual in Spanish

Education and Experience
Required:

• A master's degree in social work, Clinical Psychology, or Psychology is required. A concentration in Gerontology, Pediatrics, Public Health, Substance Abuse, Mental Health, or other fields is preferred.
• A minimum of five (5) years of clinical work experience in the above field is required.
• An active, unrestricted License as a Clinical Social Worker (LCSW) substitutes for two years of work experience.
• Experience with providing services and addressing psychosocial issues in one of these groups: (1) adults, (2) children, and (3) young adults with disabilities and special needs is required. Experience in two or more is preferred.
• A minimum of one (1) year of case management and care coordination experience is required.
• Experience in developing member-centered individualized care plans is required.

Preferred:

• Certification in Case Management or other related certification is preferred.
• A minimum of one (1) year of experience in a clinical role at a managed care or health plan setting, Medi-Cal or Medicaid, is preferred.