Medical/Social Services 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

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

Introduction

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit https://dhss.delaware.gov/dhss/ today!

Summary Statement

This is an advanced level position with responsibilities for specialized care management/care coordination and consultative services. The ability to communicate effectively with members, providers and other agencies is integral to the position. This position requires the ability to work with the community and advocacy groups, client/constituent inquiries from all levels of government; clients and family members. This position maintains an active working relationship with our three managed care organizations assuring delivery of vital medical services.

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series. These functions are not an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, employees can complete job duties of a similar kind not specifically listed here.

• 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 and consults on the intersection of services, authorizations, and payments between the clients, providers, insurance programs and/or 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.
• Formally responds to casework inquiries and investigates complaints, assessing services or eligibility against legal entitlements or contracts.
• Provides subject matter expertise through outreach and education to program staff, community members, providers, and other stakeholders through special community events or health education and preventative services. 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.

Job Requirements Medical/Social Work Consultant II

Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

• Possession of a Bachelors 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.

Conditions of Hire

All new hires are required to report to the Statewide New Employee Orientation (SNEO) on their first day of employment. Sessions are held at designated locations in Kent or New Castle County.

Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

Benefits

To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

Selection Process

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at StateJobs.Delaware.gov .

Accommodations

Accommodations are available for applicants with disabilities in all phases of the application and employment process.

Individuals who use TDD may request auxiliary aid or service by calling [phone] or by visiting delawarerelay.com .

If you need assistance with an accommodation under the Americans with Disabilities Act (ADA) or general applicant support, you may call [phone] or email [e-mail] .

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.