Position Purpose:
Coordinates the socio economic needs and service of selected member populations across the continuum of illness. Interviews, coordinates and plans activities and behavioral routines to meet the social and medical needs of members and their families. May manages members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Provides support and/or intervention and assists members in understanding the implications and complexities of their current medical situation and/or overall personal care. May assumes a behavioral health leadership role within the interdisciplinary team to achieve optimal clinical and resource outcomes. Works with the Case Management to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the health of the Member.
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* Essential Functions: * Participates in and supports developed care plans for members with high level acuity needs utilizing social service expertise to evaluate the members need for alternative services and third party needs.
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* * Outreaches to members telephonically and/or in-person and coordinates member's case management services.
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* * Interacts continuously with members, family, physician(s), and other resources to determine appropriate behavioral action needed to address/support medical needs. Reviews benefits options, researches community resources, coordinates services, trains/creates behavioral routines and enables members to be active participants in their own healthcare.
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* * Provides telephone follow-up to ensure members have seen their PCP and are completing their treatment plan or preventive care services as defined by the PCP or guidelines.
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* * Coordinates community resources with emphasis on the development of natural support system. Coordinates benefits, regulations, laws and public entitlement programs.
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* * Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
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* * Assists in obtaining benefits for members through community resources when benefits are exhausted or not available.
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* * May manage members with severe mental illness who have high rates of behavioral health utilization and/or severe psychosocial vulnerability. Acts as team SME in order to achieve optimal clinical and resource outcomes.
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* * Performs other duties as assigned.Additional Responsibilities:
Candidate Education: Required A Master's Degree in Social Work (MSW), counseling, marriage & family or psychology Candidate Experience: Required 2+ years of experience in relevant social work and/or health care experience with client care coordination responsibilities
In New Jersey, one of the following is Required: Licensed Social Worker (LSW), Licensed Associate Counselor (LAC). Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC)
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.