Case Management Social Worker

Case Management Social Worker

General Summary: Provide varied social work services to managed care patients and their families.  Aid in development of treatment plans, patient discharge needs, and provide social, emotional and mental assessments on patients.  Act as an advocate for members and their families linking them to educational resources and community resources to support their healthcare.   The Case Management Social Worker participates in Gonzaba Medical Group (GMG) High Risk meeting and Case Management team meeting to optimize care plane, treatment plans and GMG protocols. Serves as a resource to the care team.

Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements: All duties performed will be done accurately and in a timely manner.

1. Ensures customer service is always maintained at the highest level.
2. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
3. Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
4. Participates in educational programs as needed.
5. Must have excellent written and verbal communication skills.
6. Strong attention to detail and exceptional organizational skills.
7. Bilingual fluency in Spanish and English preferred.
8. Perform other duties as assigned.

Essential Job Responsibilities:

1. Serve as a strong resource to GMG physicians, clinical staff and Case Management staff regarding community services, resources, and facilities to best serve the patients.   
2. Demonstrate knowledge of utilization management, care coordination, and current standards of care as a foundation for assessment and planning activities.
3. Assess the medical, physical, psycho-social and transition needs of patients and families in various settings (hospital, SNF, home, clinic, etc.) to create individualized transitional and social plans. 
4. Conduct periodic reassessments and adjust plans accordingly.
5. Communicate effectively with patients and families to optimize the plan of care, increase customer satisfaction, and minimize misunderstandings. 
6. Confer with physician(s), case manager, and other pertinent sources to gather and provide information to the care team. 
7. Communicate with the Managed Care Director as indicated on pertinent patients to discuss patient status, issues, questions.
8. Document pertinent patient/family communications, referral authorizations and plans into the EMR in a timely manner.
9. Document appropriately in complex care database and other associated work-related systems.
10. Maintain current knowledge of health plan benefits, health plan contracts and preferred provider network.
11. Assume responsibility for personal and professional development and maintenance of skills in social work.
12. Demonstrate effective decision-making and individual reasoning to the solution of problems.
13. Maintains strictest member and company confidentiality ensuring member health information is secured each day.
14. This position will require driving a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement.

Education and Training: Minimum high school education or equivalent required. Must be a Licensed Baccalaureate Social Worker (LBSW) from an accredited program.  Licenses are required as initial and continued employment at Gonzaba Medical Group is contingent upon this credential.

Experience: Two or more years of managed care experience preferred. At least three years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions in adult geriatric populations preferred.    

Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: Depending upon the area assigned may be 100% clinical setting or office setting in a clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position.  Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor.  Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.