POSITION DESCRIPTION

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve YOUR LIFE'S BEST WORK. (SM)

The CAHPS and HOS Social Worker is responsible to act as a liaison and assists in coordinating resources for the care of health plan members with Social Determinants of Health (SDOH), multiple co-morbidities and/or psychosocial needs. The primary scope is to provide counseling and assistance to patients and their families as requested with SDOH, personal, ethical, and environmental difficulties to enhance quality of life. The CAHPS and HOS Social Worker acts as an advocate for members and their families linking them to community resources and financial assistance programs for continued growth toward a maximum level of independence. The Social Worker will interact and collaborate with the interdisciplinary care team, which includes physicians, nurses, case managers, pharmacists, laboratory technologists, healthcare navigators, educators, dietitians and other social workers in the markets to have successful outcomes for the members.

PRIMARY RESPONSIBILITIES:

• Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements for the Center for Medicare and Medicaid Services (CMS) regulations.
• Provide member/patients with internal and external resources, and support to improve Social Determinants of Health, and CAHPS and HOS measures.
• Manage telephonic outreach campaign workload, including inbound calls, and calls made via the dialer system.
• Coordinates outpatient needs related to community resources, financial assistance programs, and long-term activity of daily living needs outside the benefit criteria of the medical insurance coverage.
• Collaborates with market Social Worker and members, PCP and specialists as needed and provides related feedback on planned interventions and outcomes of plan of care.
• Identifies and assists with patients with SDOH, high-risk diagnoses and/or patients with multiple co- morbidities who will benefit from social care coordination, contracts, providers, and facilities.
• Along with care team, reviews the need for and assists with obtaining DME, home health and other resources necessary for the patient and educates them about their community resources and options and advocating on behalf of the patient.
• Takes ownership of the total work process and provides constructive information to minimize problems and increase internal and external customer satisfaction.
• Participates in the development of appropriate QI processes, establishing and monitoring indicators. Takes corrective action when data shows a need to modify management strategies or systems.
• Attends and contribute to staff meetings.
• Adheres to organizational and departmental policies and procedures.
• Seeks ways to improve job efficiency and makes suggestions to the appropriate manager.
• Performs all duties for internal and external customers in a professional and responsible manner.
• Assists in the growth and development of self and associates by sharing special knowledge with others.
• Attends educational offerings to keep abreast of change and comply with licensing requirements.
• Maintains knowledge of the Health Plan Benefits.
• Performs all other related duties as assigned.

The pace is fast and you'll need to be comfortable managing multiple priorities. You may be required to work in multiple locations, so scheduling flexibility is essential. You must also be able to respond calmly and effectively in emergency situations.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

REQUIRED QUALIFICATIONS:

• Graduate of an accredited Master's degree Social Work Program or graduate of an accredited BSW program with an additional 2 years of experience beyond the required years of experience.
• Strong clinical background (2+ years) with broad range of experience in health care delivery setting (hospital, clinic, physician's office)
• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
• Proficient in PC software computer skills such as Microsoft Word, Excel, Power Point, and other departmental specific programs/applications.
• Independent problem identification/resolution and decision making skills.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.

PREFERRED QUALIFICATIONS:

• Active/unrestricted licensed masters (TX and/or FL) prepared Social Worker or LCSW
• Knowledge of CAHPS and HOS, SDOH, managed care, medical terminology, referral process, claims, and ICD-9 and CPT coding.
• Experience working with geriatric and psychiatric patient populations.
• Bilingual (English/Spanish) language proficiency.

CAREERS WITH WELLMED. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do YOUR LIFE'S BEST WORK.(SM)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.