Social Worker - Care Manager

UHS • McAllen, TX

1d

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/
Job Summary:
Under the supervision of the Care Management Clinical Program Manager, the MSW Care Manager is responsible for providing care management services for medically and/or socially complex members. The target member population includes individuals with complex medical conditions, social-economic, or mental health needs. The goal of the program is to assist these members in achieving optimal health and/or independence in managing their care. To achieve this goal the MSW Care Manager will demonstrate and apply knowledge of the philosophy/principles of comprehensive case management, patient-centered, culturally sensitive care coordination, and management of complex members. The MSW Care Manager will adhere to the CMSA Standards of Practice for Case Management.
The MSW Care Manager is responsible for developing comprehensive care plans for member and family self-care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan. The MSW Care Manager assesses the member’s needs, and creates and monitors a specific individualized care plan, including end of life planning. The MSW Care Manager promotes knowledge of the Care Management program to Prominence Health Plan contracted physicians, as well as members. In addition, s/he is responsible for developing and sustaining partnerships with community resources and support agencies.
Additionally, the position includes participation in efforts associated with the successful implementation and operation of the SNP CM program and that the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA

Requirements

• Masters degree in Social Work, required.
• Active, unrestricted, current, and valid Social Work licenses in the States of Practice (Texas), required.

Nice To Haves

• Minimum of three (3) years of Case Management/Transition of Care experience in a managed care outpatient or community environment, preferred.
• Experience working with the Medicare and Medicaid population segment, preferred.
• Recent working knowledge of Milliman Care Guidelines, preferred.
• Ability to effectively communicate in English (Nevada, Texas, and Florida markets). Preferred Spanish (Texas and Florida markets), and/or Spanish, French Creole, and/or Tagalog (Florida market), both verbally and in writing depending on the State of RN licensure and employment location, preferred.
• Knowledge of Medicare/ Medicaid processes and compliance standards, preferred.

Responsibilities

• providing care management services for medically and/or socially complex members
• developing comprehensive care plans for member and family self-care competence, including motivational assessment, assessing for desired level of involvement, and coaching for adherence to the care plan
• assesses the member’s needs, and creates and monitors a specific individualized care plan, including end of life planning
• promoting knowledge of the Care Management program to Prominence Health Plan contracted physicians, as well as members
• developing and sustaining partnerships with community resources and support agencies
• participation in efforts associated with the successful implementation and operation of the SNP CM program and that the model of care (MOC) meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: benefits.uhsguest.com

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees