Job Description

TEMPORARY POSITION

FLSA Status: Exempt

Department: Case Management

Reports To:Health Services Management

GENERAL DESCRIPTION OF POSITION

The Social Work Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the Social Work Case Manager II facilitates communication and coordination among all participants of the care team, to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the Social Work Case Manager II provides psychosocial and behavioral case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitates the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Conduct, review and document comprehensive psychosocial assessments for assets and deficits and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member’s physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs.

2. Maintain case files by ensuring that they are documented timely in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements.

3. Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. Provide appropriate social work interventions to members and/or family/responsible party with related psychosocial process teaching and information.

4. Coordinate member’s care with primary care providers, specialists, behavioral health providers, Long Term Services and Supports providers, public services, community providers, and vendors as necessary and appropriate to assist member to achieve and maintain optimal level of functional independence to reside in the most appropriate level of care.

5. Communicate and coordinate member’s psychosocial and behavioral health needs with member’s interdisciplinary care team including SCFHP internal staff, as well as the member’s providers, specialists, public services, community agencies and vendors to ensure appropriate care plan development and successful coordination of benefits and services aligned with the member’s preferences.

6. Assist member’s interdisciplinary care team in understanding social and emotional factors related to health condition and potential barriers and coping mechanism to accessing care.

7. Provides guidance, education and referrals to help members seek solutions to specific social, cultural, or financial problems that impact their ability to manage their health care needs.

8. Conduct telephonic and in-person interview, baseline assessments, survey, assess self-care ability, assess knowledge and adherence, comprehensive clinical assessments as indicated, and developing member centric plan in the office, home, facilities, clinics, or community settings.

9. Collaborate with team members on cross-departmental improvement efforts, organizational and departmental objectives, quality improvement projects, optimization of utilization management, and improvement of member satisfaction.

10. Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed.

11. Perform other duties as required or assigned.

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Master’s Degree in Social Work, or related field. (R)

2. Certified Case Manager (CCM). (D)

3. Active California registered Licensed Clinical Social Worker (LCSW) without restriction. (R)

4. Minimum three years of experience in social work, behavioral health, or case management, or education or certifications, or equivalent experience. (R)

5. Knowledge of social case management and conflict resolution. (R)

6. Knowledge of long-term services and supports, behavioral health and/or relevant public services and community resources. (R)

7. Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R)

8. Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)

9. Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D)

10. Ability to work within an interdisciplinary team structure. (R)

11. Travel to off-site locations for work such as in office, home, facility, clinic, and other community settings. (R)

12. Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)

13. Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R)

14. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R)

15. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)

16. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by social work scope of practice. (R)

17. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)

18. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)

19. Ability to maintain confidentiality. (R)

20. Ability to comply with all SCFHP policies and procedures. (R)

21. Ability to perform the job safely and with respect to others, to property and to individual safety. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)

2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)

3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)

4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)

5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)

6. Reasoning Requirements:ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.