WHY CALOPTIMA? CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community’s health. If you’re looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.

JOB SUMMARY

This Social Worker (Care Manager) will assess prospective members for the various programs available. The incumbent is responsible for developing, implementing, monitoring, modifying, and documenting care plans. The incumbent accepts referrals for case management and makes recommendations for the appropriate level of care and measures needed to successfully manage care.

POSITION RESPONSIBILITIES:

• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
• Collaborates with an interdisciplinary team to identify and work toward timely resolution of issues related to psychosocial needs, including assistance with financial issues, transportation and community support services.
• Assists in the coordination of the member’s identified psychosocial needs, utilizing community resources and support when appropriate.
• Works with external utilization management personnel and the community in identifying members who could benefit from case management services and to actualize service plans.
• Provides social work consultation and education to members and their families and acts as an advocate when needed.
• Develops and maintains a network of current community resources and services where members can be referred for assistance.
• Analyzes assessments to identify individual issues, problems, and resources that are most appropriate to meet the member’s needs.
• Monitors all services provided to a member, assuring that all necessary and available resources are being utilized.
• Evaluates and anticipates members’ needs, provides support, maintains a role as the members’ liaison while forecasting independence and decision-making on their part.
• Provides referrals based on the members’ assessed needs.
• Partners and communicates with the member, family members, significant other(s), physicians and other health care providers to accomplish goals identified on the care plan.
• Participates in proactive identification of members appropriate for care management.
• Initiates appropriate follow-up care and develops individual care management service/care plans incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management.
• Accepts referrals for case management and serves as CalOptima liaison to community agencies, organizations, and State of California personnel.
• Maintains documentation of case management plans/interventions and statistics required to demonstrate impact of case management or quality, cost effective care.
• Initiates case conferences as needed.
• Completes other projects and duties as assigned.

POSSESSES THE ABILITY TO:

• Effectively interview members to determine strengths, problems prognosis, functional status, goals and need for specific services/resources, and to establish short-term and long-term goals.
• Develop a plan, when indicated, through multi-disciplinary collaboration which identifies options and goals.
• Identify, procure and coordinate services and resources necessary to implement the client’s service plan.
• Provide an ongoing evaluation of the client’s progress, effectiveness of the service plan, as well as the efficacy and appropriateness of the services provided.
• Advocate on behalf of the individual to assure quality of care and attainment of appropriate goals.
• Establish and maintain effective working relationships with CalOptima leadership and staff, other programs, agencies and the population served.
• Communicate clearly and concisely, both verbally and in writing, as well as at all organizational levels and in situations requiring instructing, persuading, negotiating, consulting, and advising.
• Prepare clear, concise written and oral reports and materials, including effective charting.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

EXPERIENCE & EDUCATION:

• Master’s degree in Social Work is required.
• 2 years of experience working with the gerontology population is required.
• Experience with behavioral health, health facility, health plans, counseling, case management, home health or hospice is required.
• Valid driver’s license and vehicle, or other approved means of transportation, an acceptable driving record, and current auto insurance will be required for work away from the primary office 50% of the time or more.

PREFERRED QUALIFICATIONS:

• Bilingual in English and in one of CalOptima's defined threshold language (Spanish, Vietnamese, Korean, Farsi, Arabic, and Chinese) is preferred.

KNOWLEDGE OF:

• Principles and practices of health care, health care systems, and medical administration.
• Guidelines and regulations specific to case management activities within assigned program.
• Medicaid services, regulations, and populations served.
• Care management techniques of assessment, care planning, and documentation.
• A wide variety of medical problems, appropriate treatments, and resources.
• Availability and means of utilizing community resources for special services.
• Medical utilization management.
• Discharge planning techniques.

DEPARTMENT(S):  Multipurpose Senior Services Program (MSSP) REPORTS TO:  Manager, MSSP or Supervisor, MSSP FLSA STATUS:  Non-Exempt SALARY GRADE:  J - $31.25 - $48.13 ($65,000 - $100,100)

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

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If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.  You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

Required Skills Required Experience