Social Worker Care Manager I

30030 Health Services for Children with Special Needs, Inc.; United States; On-site; USD 65,124 - 108,555; Full time

Job summary

30030 Health Services for Children with Special Needs, Inc. is seeking a Care Manager I to provide essential care coordination services. The position requires managing caseloads, conducting assessments, and collaborating with multidisciplinary teams to develop comprehensive care plans.

The ideal candidate must possess a Master's degree and a graduate social worker license in DC, along with strong communication and organizational skills. A bilingual preference in Spanish is an asset. This role is crucial for ensuring high-quality support to children with special needs.

Qualifications

• Master’s Degree in a relevant field is required.
• Minimum 2 years of experience in managed care or care management.
• Graduate Social Worker License as LGSW is required.

Responsibilities

• Manage caseload per care management requirements.
• Conduct assessments and face-to-face visits.
• Develop and update care plans with the multidisciplinary team.
• Document findings and interactions with enrollees.

Skills

Effective verbal and written communication skills

Bilingual (Spanish speaking)

Familiar with medical terminology

Proficiency with Microsoft Office

Strong organizational skills

Good judgment

Education

Master’s Degree

Graduate Social Worker Licensed in DC (LGSW)

Job description

Overview

Kids Are Our Everything. Department 10514 HSCSN - Care Management. Pay Range: $65,124.80 - $108,555.20. Under the direction of the Supervisory Care Manager, the Care Manager I (CMI) provides comprehensive care coordination services to members enrolled in the Health Services for Children with Special Needs (HSCSN) health plan.

Qualifications

• Master’s Degree (Required)
• Minimum 2 years of experience in managed care and/or care management (Preferred)
• Minimum 2 years of experience in clinical or community resource settings (Preferred)

Required Skills & Knowledge

• Effective verbal and written communication skills
• Bilingual (Spanish speaking) preferred
• Familiar with medical terminology
• Proficiency with computer systems and applications, particularly Microsoft Office suite
• Strong organizational skills
• Ability to interpret and apply departmental requirements
• Sound decision making and good judgment
• Ability to work under pressure and meet deadlines while maintaining a positive attitude and exemplary customer service
• Ability to participate in professional, multidisciplinary meetings with internal and external staff

Required Licenses & Certifications

• Graduate Social Worker Licensed in DC as a Licensed Graduate Social Worker (LGSW) (Required)
• Certified Case Manager (Preferred)

Job Functions / Responsibilities

• Manage caseload as outlined by CASSIP and Care Management Leadership, maintaining compliance with contractual and care management requirements.
• Contact enrollees at predetermined intervals based on stratification level or more frequently as needed.
• Conduct face‑to‑face visits at a frequency determined by stratification level or more if needed.
• Assess enrollees on enrollment and at intervals to identify needs/barriers and close gaps in care.
• Identify over/under utilization promptly and take appropriate action according to organizational policy.
• Collect health, mental/behavioral health, environmental, psychosocial and educational information to develop, implement and update individualized comprehensive care plans in collaboration with the PCP and other multidisciplinary team members.
• Complete routine care coordination and care management activities with attention to quality, timeliness and compliance with company policy and national standards.
• Consult with Senior Care Manager to review and prioritize cases, set objectives, identify and report potential risk and utilization concerns.
• Seek advice from Senior Care Manager or other specialized staff when necessary.
• Accurately and timely document enrollee findings and interactions according to organizational policy.
• Receive supervision by licensed staff according to oversight guidelines.
• Understand and abide by HSCSN’s confidentiality policy regarding enrollee information.
• Participate in disposition and discharge planning activities, contributing to the discharge plan in a timely manner.
• Assist enrollees and caregivers in understanding the importance of EPSDT and compliance with all health services, achieving target compliance for preventive medical and dental services.
• Assist with scheduling and monitoring compliance of mental health/medical appointments.
• Follow department policies for identifying and reporting noncompliance, missed appointments, and other reportable incidents.
• Apply advanced knowledge of target population conditions and standard approaches to care management.
• Attend multidisciplinary meetings and off‑site meetings with other agencies as needed.
• Receive and review reports of vendor visits and facilitate follow‑up care coordination.
• Refer enrollees/caregivers to appropriate vendors for DME/assistive technology use, medication education and self‑management.
• Assist enrollees in planning transitions of care across various settings and providers.
• Enter authorizations for services requiring authorization by Care Management staff.
• Maintain professional, courteous, customer‑focused demeanor in all interactions.
• Demonstrate knowledge of medical terminology and health care delivery systems.
• Apply time management and organizational skills effectively.

Other Duties

• Perform other duties in addition to those outlined in this job description.

Benefits

The disclosed salary range reflects the minimum and maximum rates within which Children’s National believes an individual’s base pay will fall for this position. The exact pay will be based on various factors in alignment with the compensation philosophy. This base salary range does not include the comprehensive benefits package or other compensation the position may be eligible for.

EEO Statement

Children’s National is a committed equal‑opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender identity or other characteristics protected by law. The “Know Your Rights” poster, pay transparency policy and nondiscrimination poster are available to applicants.