Case Manager Licensed Social Worker

Overview Ready to Transform Lives Through Comprehensive Care Coordination and Advocacy?We're seeking a compassionate social work professional who can telephonically manage cases while addressing the full spectrum of patient needs—physical, psychosocial, emotional, spiritual, environmental, and financial. As our Case Manager, you'll develop treatment plans for standard and catastrophic cases while advocating for patients, facilitating quality care delivery, and implementing cost management strategies that achieve optimal outcomes. Responsibilities What makes this role different ✓ Holistic assessment: Conduct thorough evaluations addressing physical, psychosocial, emotional, spiritual, environmental, and financial needs ✓ Complex case management: Develop treatment plans for both standard and catastrophic cases in collaboration with patients, caregivers, and multidisciplinary teams ✓ Cost management expertise: Negotiate and implement strategies that affect quality outcomes while documenting cost avoidance and intervention effectiveness ✓ Advocacy focus: Champion patient needs by facilitating quality care delivery and providing emotional support and guidance throughout care continuum What You'll Actually Do 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. Qualifications What You Bring to Our Mission The social work foundation: • 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 The technical competencies: • 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 The professional competencies: • 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 The compliance standards: • 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 No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you! Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice. In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $23-$29. Note that compensation may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits. We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing. #WeAreHiring #PersonifyHealth #TPA #HPA #Selffunded Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to [email protected]. All of our legitimate openings can be found on the Personify Health Career Site. Application Deadline: Open until position is filled. Apply tot his job