Care Management, Social Worker

The Job

Support high risk members by providing person-centered interventions to support serious mental illness, substance use disorder, and behavioral barriers to care. Collaborate with the care team to assess, develop, and implement care plans while addressing health, behavior, and psychosocial needs through telephonic, virtual, or in-person visits. Focus on holistic support to enhance independence and prevent unnecessary healthcare events, including ER visits and hospital admissions.

You Will

Conduct comprehensive assessments to identify chronic conditions and psychosocial challenges affecting independent living, prevent utilization and support member’s overall goals of care.

Manage and provide targeted support for members with serious mental illness, substance use disorder, and behavioral barriers to care, including those identified as high-risk, ensuring comprehensive care and appropriate interventions.

Ensure the clinical appropriateness of member-centered care plans by evaluating assessment findings against evidence-based guidelines, clinical reasoning, and best practices. Integrate clinical insights and community standards to develop comprehensive and effective care strategies.

Provide education and coaching surrounding behavioral and mental health treatment, interventions, and pharmacological approaches. Work with members in the prevention of illness, promotion of health, and management of member’s adjustment to chronic health problems.

Strong collaboration with internal and external providers, specifically with BH / MH vendors and programs. Serve as the key point of contact for complex behavioral health cases to assist with care coordination and act as Subject Matter Expert (SME)

Exhibit comprehensive member engagement and patient activation skills with the ability to communicate complex medical and behavioral health interventions cohesively with overall plan of care.

Perform Enhanced Care Management (ECM) activities related to specific Populations of Focus (POF) : Individuals Experiencing Homelessness, Individuals At Risk for Avoidable Hospital Or ED Utilization, Adults Living In the Community At Risk of LTC Institutionalization, Adult Nursing Facility Residents Transitioning Back to the Community.

Actively participates in interdisciplinary planning and case conference meetings to ensure person-centered care and to ensure member receives support following discharge from an inpatient or institutional setting. Build strong working relationships with the Medical Groups, vendors, and community organizations.

Utilizes department desktop procedures, workflows, job aids and training material. Identifies barriers to work processes and brings to the attention of the supervisor / manager.

Actively Adheres to all quality, compliance, and regulatory standards, and supports the achievement of SCAN’s Vision and Goals.

All other duties as assigned.

Your Qualifications

Masters in Social Work (MSW) required.

Bilingual Spanish / English strongly preferred. Test will be administered to assess proficiency.

Licensed Clinical Social Worker preferred; CCM preferred.

3-5 years managed care, healthcare environment, or mental health case management.

2 years working with seniors and working remotely strongly preferred.

Technical expertise - Advanced analytical skills

Problem Solving - Basic problem-solving skills

Communication - Good communication and interpersonal skills

Strong interpersonal skills, including excellent written and verbal communication skills.

Strong organizational skills.

Strong critical thinking skills.

Ability to collaborate effectively with a multidisciplinary team.

Ability to appropriately maintain confidentiality.

Ability to communicate complex medical information with simplicity and kindness and build strong rapport.

General understanding of NCQA standards, CMS and DHCS regulations.

Tuberculosis Screening Policy

To ensure the health and safety of our members, if you are selected for this position, your job offer with SCAN will be contingent on providing proof of Tuberculosis screening upon hire or providing proof of a negative screening within the last year. If you have a disability / medical reason or sincerely held religious belief that prevents you to provide information required in this policy, SCAN will initiate and engage in the interactive process to evaluate what, if any, reasonable accommodations may be available.

What's in it for you?

• Base salary range : $$ to $ per hour
• Internal title : Care Manager, II-LCSW
• Work Mode : Hybrid - Remote & Field (position will travel about 30% in SW Riverside county and SD County)
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!