Medical/Social Services Consultant II

State of Delaware•Dover, DE

About The Position

This is an advanced level position with responsibilities for specialized care management/care coordination and consultative services. The ability to communicate effectively with members, providers and other agencies is integral to the position. This position requires the ability to work with the community and advocacy groups, client/constituent inquiries from all levels of government; clients and family members. This position maintains an active working relationship with our three managed care organizations assuring delivery of vital medical services.

Requirements

Possession of a Bachelors degree or higher in Health, Behavioral or Social Science or related field.
Two years' experience in case management such as assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
Two years' experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
Two years' experience in client healthcare resource coordination and support.
Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
Six months experience in narrative report writing.

Responsibilities

Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions.
Facilitates access to medical and social service resources across public, private, and community sectors.
Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions.
Integrates care and communication between stakeholders to ensure optimal health and social outcomes.
Navigates and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or Managed Care Organizations.
Works with providers and insurance entities to obtain pre-authorizations and referrals.
Schedules and attends multidisciplinary evaluations and assessments.
Facilitates and participates in discharge and transition planning.
Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts.
Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services.
Advocates for community health and wellness.
Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning.
Coordinates and allocates funding sources for special program eligibility.
May support emergency preparedness and response efforts during pandemics or natural disasters, and/or intervene in facilitating care for clients in health crisis.
May provide home visits, and/or virtual appointments.
Performs other related duties as required.