Medical Social Worker (MLTC)

Medix; New York (NY); Remote; USD 70,000 - 78,000; Full time

Job summary

A leading company is seeking a Social Worker Care Manager (LMSW / MSW) to provide care management through assessment, planning, and advocacy. This remote position requires local presence in NYC for occasional office visits. The role involves managing a caseload, coordinating services, and ensuring quality outcomes for members.

Qualifications

• Comfortable managing a caseload of 200-250 members monthly.

Responsibilities

• Assess, plan, and provide ongoing care management across various settings.
• Collaborate with healthcare providers, family, and payors to ensure optimal service delivery.
• Monitor and evaluate the effectiveness of care plans and interventions.

Skills

MLTC Care Management

Insurance Case Management

Medicaid

Job description

Job Title: Social Worker Care Manager (LMSW / MSW)

Location: Remote, but must be local to NYC, as you may be asked to report approximately 6 times a year in the office.

Schedule / Shift: Monday - Friday, 8:30 AM - 5:00 PM

Pay: $70,000 - $78,000

Must Have Skills / Qualifications:

• MLTC Care Management
• Insurance Case Management
• Medicaid
• Comfortable managing a caseload of 200-250 members monthly

Job Summary:

Provides care management through assessment, planning, facilitation, and advocacy to meet members' health needs, promoting quality and cost-effective outcomes. Ensures members remain in the most independent living situation possible by assessing and monitoring their needs across the healthcare continuum. Coordinates services within a capitated managed care system, collaborating with primary care providers, interdisciplinary teams, and family members. Works under general supervision.

Key Responsibilities:

1. Assess, plan, and provide ongoing care management across various settings, developing and negotiating care plans with members, families, and physicians.
2. Evaluate living conditions, cultural influences, and functioning to identify needs; develop comprehensive care plans.
3. Assess eligibility for program services based on health, medical, financial, legal, and psychosocial factors, both initially and ongoing.
4. Set specific, actionable, time-bound, and cost-effective objectives and goals.
5. Implement care management activities and interventions to achieve the care plan goals.
6. Coordinate and arrange for long-term care services in the community, including nursing care, adult day care, rehab facilities, etc., and manage service authorizations and assessments.
7. Collaborate with healthcare providers, family, and payors to ensure optimal service delivery.
8. Monitor and evaluate the effectiveness of care plans and interventions, making adjustments as needed.
9. Identify community trends and needs to inform intervention planning.
10. Support members during transitions between care settings, coordinating with discharge planners and HCCs.
11. Manage expenditures to ensure cost-effective use of services within a capitated rate.
12. Provide social work services in accordance with NASW standards, agency policies, and regulations.
13. Participate in outreach and community engagement activities to promote program awareness and collaboration.
14. Contribute to program development for specific patient populations.
15. Document all services according to standards and regulations.
16. Participate in special projects and perform additional duties as assigned.