Social Worker - SNP (Peak Health)

Peak Health; Core (WV); On-site; USD 65,000 - 90,000; Full time

Job summary

Peak Health in West Virginia is seeking a SNP Social Worker to join our medical management team. You will support the SNP Care Manager in coordinating benefits, connecting members to community resources, and supporting members with behavioral health and social determinants of health needs.

The role requires a master's degree in social work and WV/LISW/LCSW licensure, plus two years of clinical experience. You will participate in care management, CMS SNP Model of Care compliance, and collaborate

Qualifications

• Two years of clinical experience.
• Master's in Social Work from an accredited program.
• Current social worker licensure in applicable states.

Responsibilities

• Participate in activities related to care management program build and oversight.
• Assist in CMS SNP Model of Care (MOC) compliance and NCQA standards.
• Perform psychosocial, economic care management interventions for members with major mental health or emotional disorders.
• Conduct telephonic behavioral health assessments of environmental, behavioral, psychological and social factors.
• Develop individualized, culturally sensitive care plans with CM collaboration.
• Document accurately to ensure coordination of care needs.
• Collaborate with interdisciplinary team to access community resources.

Education

Master's Degree in Social Work

West Virginia LGSW/LCSW/LISW licensure

Pennsylvania LSW/LCSW licensure

Ohio LSW/LISW/LISW-S licensure

Maryland LMSW/LCSW/LISW-C licensure

Two years of clinical experience

Job description

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position.

Reporting to SNP Care Management Operations leadership, the SNP Social Worker will be an integral member of the health plan’s medical management team. The SNP SW will assist the SNP Care Manager in the coordination of benefits with MA and Medicaid and connecting members to community resources. The SW will be an important part of the ICT in members with BH and SDOH needs. This position is committed to the constant pursuit of excellence in improving the health status of our members and community. This team member will have high organizational visibility and responsibility in ensuring overall excellence in all areas of care management.

Mininum Qualifications

Education, Certification, and/Or Licensure

• Masters Degree in Social Work or related field.
• Current social worker licensure for applicable service area:
• West Virginia – Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW) or Licensed Independent Social Worker (LICSW) through the West Virginia Board of Social Work.
• Pennsylvania – Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists and Professional Counselors.
• Ohio – Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Independent Social Worker‑Supervision (LISW‑S) through the Ohio Board of Social Work.
• Maryland – Licensed Masters Social Worker (LMSW), Licensed Certified Social Worker (LCSW), or Licensed Certified Social Worker‑Clinical (LISW‑C) through the Maryland Board of Social Work.

Experience

• Two (2) years of clinical experience.

Preferred Qualifications

Education, Certification, and/Or Licensure

• LICSW certification in the state of West Virginia.

Experience

• Management of Medicare and/or Medicaid populations.
• Two (2) years of Behavioral Health experience.

Core Duties and Responsibilities

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.
• Perform psychological, social and economic care management interventions for members with severe/persistent mental or emotional disorders.
• Perform telephonic behavioral health comprehensive assessments of members’ environmental, behavioral, psychological, economic and social factors.
• Assist in the development of individualized and culturally sensitive care plans in collaboration with the member’s assigned CM, identifying problems, interventions, barriers and goals.
• Perform telephonic re‑assessments, care plan revisions and evaluating the effectiveness of the members’ care plan.
• Member of the ICT for members with SDOH and BH needs and participates in ICT meetings when appropriate.
• Recognize early signs of a member’s decompensation that requires immediate case management intervention that promotes and motivates compliance with treatment plan.
• Serve as an additional point of contact during transitions of care.
• Co‑manage member cases with the CM to address psycho‑social, economic and cultural issues that may impact the members’ care needs.
• Serve as a primary socio‑economic resource for the D‑SNP Care Management Team.
• Document in the members’ case accurately and timely to ensure coordination of the members’ care needs.
• Adhere to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC.
• Collaborate with all members of the interdisciplinary care team to facilitate appropriate community resource assistance for members with identified needs.
• Screen, identify, diagnose, treat and manage mental health and/or substance abuse problems in patients and family members.
• Maintain knowledge of hospital, medical center and/or health system resources to access and provide for patient care needs.
• Maintain a working knowledge of community agencies and resources and serve as a liaison between them and the healthcare system.
• Collaborate for appropriate resource and financial management, including but not limited to financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.

Physical Requirements

• Ability to stand and walk short distances for eight or more hours.
• Frequent bending, stooping, or stretching.
• Ability to lift 30 pounds and push 50 pounds.

Working Environment

• Standard office environment.
• Some travel may be required to off‑site meetings.

Skills and Abilities

• Demonstrated knowledge of CMS regulatory and contractual documents; knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
• Excellent written and oral communication.
• Problem solving capabilities to drive improved efficiencies and customer satisfaction.
• Attention to detail.
• Proficiency with Microsoft Office products.
• Ability to work under stressful working conditions.
• Meeting defined deadlines and deliverables is an imperative skill for this role.