Job Details
Job Description
It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary
The Social Work Care Manager (SWCM) works collaboratively with the patient centered care team. The SWCM arranges, coordinates, monitors, evaluates and advocates for services to meet the psychosocial needs of the member. The SWCM works with the member to increase their capacity for self-management and to promote behavioral changes that facilitates short and long term linkages with necessary community, social service, medical or behavioral health resources. The population includes both adult and pediatric members many of whom, may require LTSS, are developmentally delayed, recent Refugee's, are diagnosed with severe persistant mental illness or are identified as having special needs.
Our Investment in You:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities
- Utilizes motivational interviewing techniques, systems theory, change theory, acceptance and commitment approaches, patient activation and psycho-education to engage members in care management
- Supports and enhances the member's capacity to self-manage by detecting underlying mental/behavioral health issue impacting general health
- Establishes and maintains effective working relationships and provides outreach and education to key service agencies, providers and other members of the interdisciplinary team
- Maintains flexibility and adjusts approach to the needs of the member and the team.
- Meets with members, family, supports, during office visits, at member's home, or, in the community
- Regular and reliable transportation and the ability to conduct face-to-face appointments
- Assists the member, when necessary, in placing calls, completing applications, and advocating for available supports/services
- Maintains general knowledge of the most common conditions presented in the Medicaid population and is able to assess, manage and triage at risk, high needs members.
- Researches and shares community resources with members and peers.
- Contributes to the development of an individual care plan [ICP] for the member
- Collaborates with Wellsense CWA to provide in home/face to face visits to enhance member engagement and communication
- Develops and maintains community relationships providing outreach to community and state agencies and school systems
- Facilitates interdisciplinary consultation on members' behalf through participation in rounds, team meetings and clinical reviews.
- Conducts face-to-face visits with selected members as appropriate.
- Regular and reliable transportation and the ability to conduct face-to-face appointments with members, providers, community and state agencies
- 2 years of experience working with individuals with complex medical/behavioral and/or psychosocial needs
- 2 years of experience working with incarcerated individuals and/or with the Department of Corrections
- Completes documentation in the medical management information system in a timely manner and in keeping with, internal policy, accreditation and HIPPA standards.
- Other duties as assigned.
Supervision Received- Regularly scheduled meetings with Manager of Care Management
QualificationsEducation Required:- Master's Degree in Social Work, Psychology, Education, Public Health or a related field required.
Education Preferred:- Active state licensure as a Social Worker or related field strongly preferred.
Experience Required:- 2 years of experience working with individuals with complex medical/behavioral and/or psychosocial needs
- 2 years of experience working with incarcerated individuals and/or with the Department of Corrections
Experience Preferred/Desirable:Required Licensure, Certification or Conditions of Employment: - Pre-employment background check
Competencies, Skills, and Attributes: Strong oral and written communication skills
Ability to establish and maintain effective working relationships with members, social service agencies, community resources
and other members of the interdisciplinary team.
Ability to work with members to promote positive behavioral change
Strong Motivational Interviewing skills
Bilingual desired
Strong organizational and time management skills
Ability to work in a fast paced environment
Proficient Microsoft Office skills particularly MS Outlook and MS Word and other data entry processing applications
Knowledge of medical terminology
Working Conditions and Physical Effort Regular and reliable attendance is an essential function of the position.
Work is generally remote from home office with in person visits in the community when indicated. . No or very limited
physical effort required.
No or very limited exposure to physical risk.
About WellSenseWellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees