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About The Position

Coordinates care for members with long-term rehabilitation and/or psychosocial needs related to birth defects, chronic conditions, illness, or injury, with the goal of preventing exacerbations, readmissions, or placement in custodial care. Implements and coordinates case management, psychosocial, and quality-of-life activities across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care. Develops and carries out strategies to coordinate acute and long-term care services for members involved in case and disease management, and provides psychosocial interventions through resource identification, program development, and other means. The role may specialize in a disease area and may consult with other health care professionals. The position manages members with acute or chronic conditions, conducts initial and periodic assessments, and develops individualized case plans for members at risk of poor outcomes. It coordinates with providers and internal care teams, helps members access covered care in home or community settings, and provides education and resources related to social issues, mental health, and available services. The role also develops programs to reduce admissions, improve community integration and health outcomes, coaches junior colleagues, and collaborates with community organizations and policymakers. This is a work-at-home position with 25–50% travel throughout Wayne and Macomb Counties. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Reliable transportation is required; mileage is reimbursed under the company expense reimbursement policy.

Requirements

  • At least 2 years of experience in medical social work or case management.
  • Comply with all state requirements in the state where job duties are performed.
  • Willingness and ability to travel 25–50% of the time in Wayne and Macomb Counties.
  • Reliable transportation.
  • Basic awareness of problem-solving and decision-making skills.
  • Basic awareness of digital literacy skills.
  • Basic knowledge of medical terminology.
  • Ability to deal tactfully with customers and the community.
  • Ability to handle sensitive information ethically and responsibly.
  • Ability to weigh the relative costs and benefits of potential actions to select an appropriate option.
  • Ability to function in clinical settings with diverse cultural dynamics among staff and patients.
  • Bachelor’s degree in Social Work, as required by state law.
  • LLBSW, LBSW, or LLMSW.

Nice To Haves

  • Behavioral health experience.
  • Bilingual in Spanish or Arabic.

Responsibilities

  • Manage members with acute or chronic conditions, focusing on quality of care, compliance, outcomes, and reducing costs.
  • Conduct initial and periodic assessments of members enrolled in Long-Term Care, case management, or disease management programs.
  • Develop individualized case plans for enrolled members at risk of poor outcomes.
  • Coordinate case management, psychosocial, and quality-of-life activities across the continuum of care, including referrals, home care visits, community resources, and alternative levels of care.
  • Coordinate and integrate acute and long-term care services for members in case and disease management.
  • Communicate updates and facilitate discussions with providers, primary care physicians, Medical Directors, pharmacists, and care management staff about patient status.
  • Identify opportunities for members to receive covered care in home or community settings.
  • Provide information, resources, and education on social issues, mental health, and available services.
  • Develop programs to reduce admissions, increase community integration, and improve health outcomes.
  • Coach junior colleagues in social work techniques, processes, and responsibilities.
  • Collaborate with community members, organizations, and policymakers to create opportunities for clients, address community issues, and raise awareness.

Benefits

  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources to support colleagues’ physical, emotional, and financial well-being, based on eligibility
  • CVS Health bonus, commission, or short-term incentive program eligibility

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