Case Manager Social Work

Job Summary Coordinates, negotiates, procures and manages care of patients to facilitate cost effective care and patient satisfaction. Facilitates the continuum of care, works collaboratively with interdisciplinary staff, internal and external to the organization. Minimum Qualifications Education/Training Master''s degree in Social Work. Licensed Independent Clinical Social Worker or Licensed Clinical/Graduate Social Worker (LICSW/LCSW/ LGSW) preferred. Experience 2 years recent care/case management experience; 3 years diverse clinical experience. License/Certification/Registration Valid Social Worker license in District of Columbia. Knowledge, Skills & Abilities Ability to use computer to enter and retrieve data. Ability to create, edit and analyze Microsoft office (Word, Excel, and PowerPoint) preferred. Primary Duties and Responsibilities Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations. Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care. Acts as an advocate while assisting members to coordinate and gain access to medical, psychiatric, psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy. Maintains working knowledge and collaborative relationships with District of Columbia agencies and resources. Attends and participates in MFC staff meetings, Clinical Operations department meetings, Special Needs Forums, work groups, District/ community agencies meetings, etc., as assigned. Provides input, completes assignments, and shares new findings with other staff. Attends court ordered hearings and helps with coordinating needed care. Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy. Demonstrates skill and flexibility in providing coverage for other staff. Identifies and reports potential coordination of benefits, subrogation, third party liability, worker''s compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel. Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-certification requests. Interfaces with the community for home visits or group meeting. Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services. Maintains timely and accurate documentation in the clinical software system per Clinical Operations department''s policies. Performs other duties as assigned. Provides ACD telephone coverage and processes calls related to PCP and provider questions, eligibility and benefits, transportation, and authorization issues. Works to actively develop assigned case management programs, such as HIV, substance use disorders. Keeps informed about disease processes, treatment modalities, and resources. About MedStar Health MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.

Created: 2021-11-29