Social Worker II Job at Baptist Health (Florida) (Jacksonville)

New

Social Work Consultant

Mental health is an essential component of total health. As mental health profes...

Location

United States , Atlanta

Salary:

37.25 - 48.17 USD / Hour

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum two (2) years social work experience identifying and managing discharge and psychosocial needs of inpatients in an acute care or managed care setting within the last five (5) years
Masters degree in social work conferred by a program accredited by the Council of Social Work Education
Licensed Master Social Worker (Georgia) required at hire OR Associate Marriage and Family Therapist License (Georgia) required at hire OR Associate Professional Counselor License (Georgia) required at hire OR Licensed Clinical Social Worker (Georgia) required at hire
Demonstrated ability to perform on a multidisciplinary team
Must have strong psychosocial assessment skills
Knowledge of chronic and acute disease and how it impacts patient and family functioning
Demonstrated excellent oral/telephone communication skills and written documentation
Must be experienced in documenting in an electronic clinical information system
Must demonstrate ability to effectively and efficiently handle demanding workload involving multiple tasks
Demonstrated ability to function independently as a collaborative, supportive team member

Job Responsibility

Discharge Planning: The primary role of the Medical Social Worker II for hospital settings is to facilitate the execution of approved and appropriate inpatient discharge plans between facilities or into the community
Under general direction of the Continumm of Care Leader and via clear and consistent communication with the onsite care management staff, delivers age-appropriate clinical social work insight and care to members and their caregivers in accordance with agency policy and procedure and state and federal regulations
The Medical Social Worker II serves as an integral member of the healthcare team ensuring coordination of discharge/transition planning and providing referrals to internal resources within the Kaiser Permanente network, information to community resources and other social work services to meet the complex needs of patients and families transitioning from hospital settings
Responsible for overseeing or participating in individual discharge plans which assist members and families to transition to the appropriate level of care upon the completion of the acute Treatment Plan with the measure of restoring social, emotional, financial, and environmental factors which affect and/or affected by the acute inpatient stay
Partners with multidisciplinary teams to identify needs and collaborate and execute individual discharge plans
Discuss options for care proactively including Kaiser resources and external community/government resources to assist member and caregiver(s) in developing short- and long-term care plans as appropriate
Collaborates with other disciplines in assessing, planning, and providing services for patients utilizing biopsychosocial information
Coaches member pre-discharge in advocating for self to receive appropriate services within Kaiser and in the community
Ensures member and caregiver(s) are updated with approved discharge plans
Takes, reviews, evaluates, and prioritizes written and oral referrals

What we offer

Medical, Vision & Dental
Professional Development
Retirement Plans
Vacation, Holiday & Sick Leave
Supportive Teams & Resources

Parttime

New

Social Work Consultant II

Mental health is an essential component of total health. As mental health profes...

Location

United States , Duluth

Salary:

37.25 - 48.17 USD / Hour

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum two (2) years social work experience identifying and managing discharge and psychosocial needs of inpatients in an acute care or managed care setting within the last five (5) years
Masters degree in social work conferred by a program accredited by the Council of Social Work Education
Licensed Master Social Worker (Georgia) OR Associate Marriage and Family Therapist License (Georgia) OR Associate Professional Counselor License (Georgia) OR Licensed Clinical Social Worker (Georgia)
Demonstrated ability to perform on a multidisciplinary team
Must have strong psychosocial assessment skills
Knowledge of chronic and acute disease and how it impacts patient and family functioning
Demonstrated excellent oral/telephone communication skills and written documentation
Must be experienced in documenting in an electronic clinical information system
Must demonstrate ability to effectively and efficiently handle demanding workload involving multiple tasks
Demonstrated ability to function independently as a collaborative, supportive team member

Job Responsibility

Discharge Planning: The primary role of the Medical Social Worker II for hospital settings is to facilitate the execution of approved and appropriate inpatient discharge plans between facilities or into the community
Responsible for overseeing or participating in individual discharge plans which assist members and families to transition to the appropriate level of care
Partners with multidisciplinary teams to identify needs and collaborate and execute individual discharge plans
Discuss options for care proactively including Kaiser resources and external community/government resources to assist member and caregiver(s) in developing short- and long-term care plans as appropriate
Collaborates with other disciplines in assessing, planning, and providing services for patients utilizing biopsychosocial information
Coaches member pre-discharge in advocating for self to receive appropriate services within Kaiser and in the community
Ensures member and caregiver(s) are updated with approved discharge plans
Takes, reviews, evaluates, and prioritizes written and oral referrals
Maintains documentation, records, and data collections
Responsible for completion of required documents in a complete and timely manner

What we offer

Medical, Vision & Dental
Professional Development
Retirement Plans
Vacation, Holiday & Sick Leave
Supportive Teams & Resources

New

Social Worker II

Baptist HealthMaster’s Level Social Worker (Social Worker II)Full-Time, Day Shif...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Master’s degree in Social Work (MSW) is required
3-5 Years Discharge Planning Experience
3-5 Years Case Management Experience
Licensed Clinical Social Worker Preferred

Job Responsibility

Assess psychosocial needs and deliver services to enhance patient functioning and emotional well-being
Coordinate care to ensure continued access to support and services
Provide psychoeducation to patients and families
Connect individuals with appropriate community resources and referrals

Fulltime

New

Social Worker II

Baptist HealthMaster’s Level Social Worker (Social Worker II)Full-Time, Day Shif...

Location

United States , Jacksonville Beach

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Master’s degree in Social Work (MSW) is required
3-5 Years Discharge Planning Experience
3-5 Years Case Management Experience
Licensed Clinical Social Worker Preferred

Job Responsibility

Assess psychosocial needs and deliver services to enhance patient functioning and emotional well-being
Coordinate care to ensure continued access to support and services
Provide psychoeducation to patients and families
Connect individuals with appropriate community resources and referrals

Fulltime

Care Management Specialist II

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

New

Social Worker II, Family Support Services

Baptist HealthSocial Worker II is seeking a compassionate and motivated to join ...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Master's Degree
1-2 years Counseling Experience Required
1-2 years Experience in Child Welfare Services Required
1-2 years Social Work Experience Required
1-2 years Hospital Experience Required
Less than 1 year Experience in Behavior Health Setting Required

Job Responsibility

Assess patients’ psychosocial needs to support emotional well-being and optimal functioning
Provide discharge planning, including coordination of home health services and durable medical equipment (DME)
Assist with patient placement and transfers, ensuring smooth transitions of care
Offer referrals to community resources to support ongoing care and family needs
Support utilization review activities to promote effective and appropriate care delivery

Parttime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Social Worker II

Baptist Health (Florida)

Location:
United States , Jacksonville

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 05, 2026

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