Social workers are responsible for providing social work services to patients and families. They function as a member of the departmental team which includes educating the patient, family and members of the healthcare team regarding benefits, community resources, referrals for counseling and other pertinent information. Social workers are also responsible for triaging referrals and collaborating on cases with other members of the healthcare delivery team. In addition, social workers must be able to assist the patient in a sensitive and supportive manner, while acting as an advocate on behalf of the patient.Major responsibilities include:
- Assesses patient and family psychosocial needs and develops plan of care in concert with patient, physicians, nurses and other members of the departmental team
- Links patients/family to appropriate community resources including but not limited to, information/referral to sources of financial assistance, transportation, support groups, and other community services
- Documents patient/family status, diagnosis, treatment plan, goals, and interventions, evaluation results, observations and progress in medical record
- Serves as patient advocate and liaison with physicians, families, insurance company, community agencies and others as needed to ensure continuity of care
- Provides discharge planning based on meeting identified goals of the treatment plan.
- Assist members by answering questions, providing program information and education about the program services, guidelines and policies in an accurate and courteous manner.
- Encourage members to appropriately utilize services in an effort to improve the health and well being of all members. This might include educational materials for specific disease management. Provide ongoing education for all members based on individual needs identified through questions or conversations, while paying attention to special social needs and issues with members.
- Complete Assessments as appropriate
- Develop and implement member-specific interventions when necessary.
- Determine when an issue requires higher-level review and input the appropriate information to ensure prompt and accurate escalation of the issue.
- Educate members on the importance of disease management and the services covered.
- Assist the member in communication with PCP pertaining to care coordination for disease management.
- Provide the member with disease management educational information as appropriate.
- Referrals to Other Resources
- Refer the member to the appropriate Medical resources when outreach or follow-up is appropriate.
- Assist members in identifying program and community resources, such as transportation.
- Develop knowledge of and linkages to other community-based organizations to improve access to services.
- Document all member and provider contacts completely and accurately to ensure accurate database tracking, statistics and member history.
- Enter appropriate information into system modules for such activities as care coordination, disease management education.
- Provide documentation of perceived system or process issues to Supervisors to assist in quality monitoring and improvement.
- Assist with projects and/or assignments designated by the Team Leader, Supervisor or Manager.
- Social Worker degree with current licensure in New York required
- Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
- 3+ years Clinical background, experience in behavioral health and complex, community case management
- Masters degree required
- Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, and Microsoft Access.
- Case management experience
- Experience in managed care
- Substance abuse experience
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