Social Worker, Care Management

EmblemHealth; New York (NY); On-site; USD 68,000 - 119,000; Full time

Job summary

EmblemHealth is seeking a skilled care management professional to coordinate comprehensive plans of care for members across New York. The role focuses on assessment, planning, and facilitating services across settings to ensure optimal health outcomes.

Qualified candidates will typically have 4–6+ years of case management experience and a preferred LCSW certification, with strong knowledge of Medicare/Medicaid regulations and excellent problem-solving abilities.

Qualifications

• Certification in clinical social work is preferred (LCSW).
• 4–6+ years of case management and/or managed care experience.
• Knowledge of Federal and State regulations for Medicare and Medicaid and other national/state funded programs.

Responsibilities

• Develop, facilitate, and communicate a plan of care in partnership with the member and care team.
• Provide care management through assessment, planning, coordination, and evaluation.
• Assist members with coordination of services across settings and facilitate transitions.
• Assess members to determine suitability for management at any point in the disease continuum.
• Assess Social Determinants of Health and mental health needs, including depression screening.
• Provide mental health counseling referrals and appropriate support.
• Aim to optimize quality of care and life and identify members for specialty programs.

Skills

Care coordination

Communication

Problem-solving

MS Office

Education

Clinical social work certification preferred (LCSW)

Tools

MS Office (Word, Excel, PowerPoint, Teams, Outlook)

Job description

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com .

Need Assistance Applying? EmblemHealth provides reasonable accommodations to individuals with disabilities throughout the application and hiring process. If you need an accommodation, please contact [e-mail] so we can support your request in accordance with applicable law.

Achieve optimal benefit and results from the comprehensive management of members with chronic and/or catastrophic illness, members who are frail elderly and/or members whose illness is complicated by challenging psychosocial conditions.Provide global, episodic, specialized or complex care management and utilization management as needed to ensure coordination of health care delivery, member education, and preventative intervention.Coordinate care in a variety of settings and provides focus on transition activities to benefit clinical needs of members while performing the care management process.Assist in managing members with behavioral health, substance abuse, and/or psychosocial conditions/issues, consulting with colleagues across the enterprise. on behavioral health, substance abuse, and/or psychosocial issues.Facilitate member adoption of strategies to promote physician recommended behavior changes.Help members improve health outcomes and provide feedback to members of the medical and care management care teams.

Principal Accountabilities

• Develop, facilitate, and communicate a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various providers.
• Provide care management through assessment, planning, implementation, coordination, monitoring, and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs.
• Assist members with the coordination of services from various settings as appropriate. Include facilitating discharge from acute setting to home and acute setting to alternate settings. Provide Care Coordination throughout the continuum of care by including the member, member’s family and providers in the process.
• Assess identified members to determine members appropriate for management early in their disease process at any time during the continuum of care.
• Assess members’ Social Determinants of Health, such as housing, food, transportation, and safety in the home; assess members’ mental health needs including PHQ2 and 9 Depression screening.
• Provide mental health counseling referrals and provide appropriate support as needed.
• Optimize the quality of care and of life for the member. Identify members appropriate for specialty programs.

Qualifications

• Certification in clinical social work (LCSW) preferred
• 4-6+ years' case management and/or managed care experience
• Knowledge of Federal and State regulations for Medicare and Medicaid and other national and state funded programs
• Knowledge of community resources access
• Proven track record in leading care management team(s)
• Strong problem-solving skills
• Detailed oriented and organized
• Proficient with MS Office (Word, Excel, Powerpoint, Teams, Outlook, etc.)

Additional Information

• Requisition ID: 1000003209
• Hiring Range: $68,040-$118,800

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from "HRTalentAcquisition" with the subject: "Offer of Employment for (job title) - Please respond online." We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn't account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.