Case Manager Social Worker

Personify Health

8d•$23 - $29•Remote

About The Position

Ready to Transform Lives Through Comprehensive Care Coordination and Advocacy?We're seeking a compassionate social work professional who can telephonically manage cases while addressing the full spectrum of patient needs—physical, psychosocial, emotional, spiritual, environmental, and financial. As our Case Manager, you'll develop treatment plans for standard and catastrophic cases while advocating for patients, facilitating quality care delivery, and implementing cost management strategies that achieve optimal outcomes.

Requirements

Graduation from accredited college with degree in Social Work required
License in Social Work preferred
Must apply for certification in case management after one year at Personify Health
Minimum 2 years acute healthcare experience including 2 years case management experience, or equivalent combination of education and experience
Basic computer literacy with ability to work on multiple screens and proficient typing skills
Proficiency in Microsoft Word, Microsoft Excel, and Outlook
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to work independently and utilize written resources to problem-solve
Excellent verbal and written communication skills for upward and downward conversations
Ability to speak clearly and convey complex or technical information in understandable manner
Capability to understand and interpret complex information from others
Ability to meet productivity, quality, and turnaround time requirements daily, weekly, and monthly
Evidence of innovative thinking with ability to assist with department operations and implementations
Ability to pass external audits including URAC and NCQA
Maintain HIPAA compliance per company policies and procedures
Maintain confidentiality and minimum requirement rules
Complete all required yearly training per company's expected timeframe

Nice To Haves

Additional training, certification, or degree outside of company preferred

Responsibilities

Manage comprehensive cases: Telephonically coordinate cases on long- or short-term basis per established guidelines, policies, and healthcare industry standards.
Conduct holistic assessments: Complete thorough patient evaluations including physical, psychosocial, emotional, spiritual, environmental, and financial needs assessment.
Develop treatment plans: Create collaborative treatment plans for standard and catastrophic cases with patients, caregivers, family, community resources, and multidisciplinary healthcare providers.
Monitor and evaluate outcomes: Track interventions and evaluate treatment plan effectiveness promptly while reporting measurable outcomes that record intervention success.
Maintain care coordination: Initiate and sustain contact with patient/family, providers, employers, and multidisciplinary teams throughout continuum of care.
Advocate for patients: Facilitate delivery of quality patient care while assisting in reducing overall costs and providing emotional support and guidance to patients and families.
Implement cost strategies: Negotiate and execute cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews and cost avoidance reports.
Build strategic relationships: Establish and maintain working relationships with healthcare providers, clients/groups, and patients to provide comprehensive support.
Maintain comprehensive documentation: Record detailed case information in Eldorado and UM Web, maintain confidential site-specific files, and prepare reports at 30-day intervals per HIPAA requirements.