Care Coordination Medical/Social Consultant II

State of Delaware; Delaware; On-site; USD 65,000 - 85,000; Full time

Job summary

State of Delaware's Department of Health and Social Services seeks an advanced level Medical/Social Work Consultant II to lead complex care management and care coordination across public, private, and community partners. You will work with providers and insurers to develop tailored service plans, navigate approvals, and ensure delivery of essential medical and social services.

The role emphasizes advocacy, outreach, and data-driven program planning to improve outcomes for vulnerable populations.

Qualifications

• Possession of a Bachelor’s degree or higher in Health, Behavioral or Social Science or related field.
• Two years' experience in case management such as assessing, planning, developing, implementing, monitoring, and evaluating options and services to meet an individual's human service needs.
• Two years' experience in making recommendations as part of a client's service plan such as clinical treatment, counseling, or determining eligibility for health or human services/benefits.
• Two years' experience in client healthcare resource coordination and support.
• Six months experience in interpreting laws, rules, regulations, standards, policies, and procedures.
• Six months experience in narrative report writing.

Responsibilities

• Manages cases over the continuum of a healthcare delivery system for clients with complex, chronic, and specialized physiological medical conditions.
• Facilitates access to medical and social service resources across public, private, and community sectors.
• Collaborates with health care providers, services, programs, and insurance entities to develop tailored service plans and interventions.
• Integrates care and communication between stakeholders to ensure optimal health and social outcomes.
• Navigates service authorizations and payments among clients, providers, insurers, and Managed Care Organizations.
• Works with providers and insurance entities to obtain pre-authorizations and referrals.
• Schedules and attends multidisciplinary evaluations and assessments.
• Facilitates and participates in discharge and transition planning.
• Responds to casework inquiries and investigates complaints.
• Provides subject matter expertise through outreach and education to staff, communities, and providers.
• Advocates for community health and wellness.
• Maintains and tracks service, eligibility, and referral data sets, manages data for reporting and program planning.
• Coordinates and allocates funding sources for special program eligibility.
• May support emergency preparedness and response efforts during pandemics or natural disasters, and/or intervene in facilitating care for clients in health crisis.
• May provide home visits, and/or virtual appointments.
• Performs other related duties as required.

Skills

Case management

Recommendations

Resource coordination

Laws interpretation

Narrative reporting

Education

Bachelor's degree or higher in Health, Behavioral or Social Science or related field

Job description

State of Delaware's Department of Health and Social Services seeks an advanced level Medical/Social Work Consultant II to lead complex care management and care coordination across public, private, and community partners. You will work with providers and insurers to develop tailored service plans, navigate approvals, and ensure delivery of essential medical and social services.

The role emphasizes advocacy, outreach, and data-driven program planning to improve outcomes for vulnerable populations.