Social Worker II

Position Description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

The Social Worker II provides services to the member using an interdisciplinary team approach. Social workers manage appropriate members independently or co-manage members with the RN care manager to address psychosocial, behavioral and clinical needs. Social workers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status. The Social Worker is responsible for the co-management and/or oversight of a caseload of moderate - high risk patients with varying medical/psychosocial needs. 

Responsibilities and Qualifications

• Uses a collaborative process and serves as a liaison between the member, family and significant others, physician(s) and other members of the treatment team. Develops prioritized goals and health actions that assist members with the implementation of appropriate self-directed care decisions and support improvement in health and self-reliance. Advocates for members and families by helping them to coordinate care and navigate resources to reduce barriers and meet personal care needs.
• Using established criteria, analyzes and evaluates referrals for potential enrollment of Members into Care Management programs. Conducts assessments to obtain information for a participant-centered plan of care and determination of acuity level, psychosocial status, & barriers to care. Obtains consent forms necessary for candidates accepted into the Case Management programs.
• Applies established criteria for discharge and discharges the Member from the Care Management Program when the criteria are met.
• Conducts all care management activities, including documentation, in accordance with established departmental policies and procedures. Complies with all Clinical Management and corporate policies and procedures.
• Builds relationships with members, their families, and implements interventions that move assigned members toward goals of improved self-management care and long term care outcomes of stabilization.
• Identifies and reports quality of care issues in accordance with established departmental policies and procedures. Maintains member confidentiality at all times.
• Attends company and departmental meetings and training sessions as required.

Skills:

• Leadership: Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel and the general public.
• Superior clinical process, critical thinking, and problem solving skills; and ability to handle critical situations.
• Excellent written, oral communication, listening and organizational skills.
• Ability to use computer system while conversing telephonically
• Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers
• Ability to influence and negotiate individual and group decision making, conflict resolution, and problem solving
• Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties.
• Ability to work autonomously and as part of an interdisciplinary team
• Demonstrates sound judgment that affirms the rights and responsibilities of Member’s, families, health care professionals and health care organizations.
• Ability to operate a personal computer (PC), including proficiency in Microsoft Word and Access.

 

Knowledge:

• Knowledge of NCQA standards for Population Health Management for health plan accreditation, CMSA Standards of Practice for Case Management, Act 68, CMS and ERISA.
• Knowledge of clinical and managed care principles and operations.
• General knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships.
• Knowledge of adult learning principles, motivational interviewing and intrinsic coaching techniques.

Experience:

• At least three (3) years’ clinical social work experience or five (5) years of behavioral health work experience required; One (1) year experience in care coordination preferred.

Education and Certifications:

• Graduate from an accredited School of Social Work with an MSW (Master’s in Social Work) degree.
• Bachelor’s degree social workers are grandfathered, but will not be hired for future employment.
• Case Management certification preferred. Subsequent to completing three (3) years in the position, the incumbent must obtain national certification as a case manager.
• Possession of a valid driver’s license and the ability to travel to provider, facility, employer group and/or member locations using own vehicle, if appropriate

Work Environment:

Hours vary depending on department and customer needs. Primarily remote work from home with expected travel to office for meetings as needed.

 

Physical Demands:

Sedentary work involving significant periods of sitting, talking, listening, typing, and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.

 

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.