Case Manager Licensed Social Worker

• Manage comprehensive cases: Telephonically coordinate cases on long- or short-term basis per established guidelines, policies, and healthcare industry standards
• Conduct holistic assessments: Complete thorough patient evaluations including physical, psychosocial, emotional, spiritual, environmental, and financial needs assessment
• Develop treatment plans: Create collaborative treatment plans for standard and catastrophic cases with patients, caregivers, family, community resources, and multidisciplinary healthcare providers
• Monitor and evaluate outcomes: Track interventions and evaluate treatment plan effectiveness promptly while reporting measurable outcomes that record intervention success
• Maintain care coordination: Initiate and sustain contact with patient/family, providers, employers, and multidisciplinary teams throughout continuum of care
• Advocate for patients: Facilitate delivery of quality patient care while assisting in reducing overall costs and providing emotional support and guidance to patients and families
• Implement cost strategies: Negotiate and execute cost management strategies to affect quality outcomes, reflecting data in monthly case management reviews and cost avoidance reports
• Build strategic relationships: Establish and maintain working relationships with healthcare providers, clients/groups, and patients to provide comprehensive support
• Maintain comprehensive documentation: Record detailed case information in Eldorado and UM Web, maintain confidential site-specific files, and prepare reports at 30-day intervals per HIPAA requirements

• Graduation from accredited college with degree in Social Work required
• License in Social Work required
• Must apply for certification in case management after one year at Personify Health
• Minimum 2 years acute healthcare experience including 2 years case management experience, or equivalent combination of education and experience
• Basic computer literacy with ability to work on multiple screens and proficient typing skills
• Proficiency in Microsoft Word, Microsoft Excel, and Outlook
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Ability to work independently and utilize written resources to problem-solve
• Excellent verbal and written communication skills for upward and downward conversations
• Ability to speak clearly and convey complex or technical information in understandable manner
• Capability to understand and interpret complex information from others
• Ability to meet productivity, quality, and turnaround time requirements daily, weekly, and monthly
• Evidence of innovative thinking with ability to assist with department operations and implementations
• Ability to pass external audits including URAC and NCQA
• Maintain HIPAA compliance per company policies and procedures
• Maintain confidentiality and minimum requirement rules
• Complete all required yearly training per company's expected timeframe

Additional training, certification, or degree outside of company preferred

health, dental, vision, mental health and other benefits