It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Social Work Care Manager, Senior Care Options works collaboratively with the care manager, the Beacon Health Strategies staff, the care coordinator and the Geriatric Services Supports Coordinator (GSSC) to collaboratively assess the needs of the member and the member’s family/caregivers when appropriate, and arranges, coordinates, monitors, evaluates and advocates for services to meet the member’s psychosocial needs. The Social Work Care Manager works with the member to increase their capacity for self-management, optimal functional level, and to promote behavioral changes that facilitates short and long term linkages with necessary community, social service, medical or behavioral health resources. The Social Work Care Managers work with the Primary Care Team (PCT) in developing and carrying out interventions of the person-centered individualized Plan of Care (ICP).

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Documents and completes clinical assessments and coordination of care in the medical management information system in a timely manner that meets regulatory and accreditation standards
• Utilizes motivational interviewing techniques, systems theory, change theory, acceptance and commitment approaches, patient activation and psycho-education to engage members in care management
• Supports and enhances the member’s capacity to self-manage by detecting underlying mental/behavioral health issue impacting general heal
• Establishes and maintains effective working relationships with members, care givers, GSSCs, social service agencies and other members of the PCT team
  • Maintains flexibility and adjusts approach to the needs of the team
• Ensures continuity of care through effective transition planning
• Provides culturally competent care coordination in keeping with the Enrollee’s racial, ethnic and sexual orientation
• Facilitates sharing of essential or psychosocial information related to Enrollee’s care
• Facilitates member access to psychosocial supports such as
  • Adequate Shelter and/or Affordable Housing
  • Adequate Access to Food Resources / Food Stamps / WIC
  • Transportation Needs / PT1/ Area Public Transportation
  • Federal and State Income / Entitlement Programs
  • Facilitates linkage and referral to ASAPs and other community-based organziations
  • Financial Assistance Programs
  • Health Plan Benefits
  • Vocational Opportunities
  • Family Resources / Furniture / Clothing
  • Peer Support Programs
  • Behavioral Health / Substance Abuse Referrals
  • Job training and interviewing skills
• Assists the member, when necessary, in placing calls, completing applications, and advocating for available supports/services
• General knowledge of the most common conditions presented in the Medicaid and Medicare population and is able to assess, manage and triage at risk, high needs/elder members
• Researches and shares community resources with members and peers
• In conjunction with the Enrollee with the PCT develops a person centered IPC
• Contributes to the development of an IPC for the member
• Utilizes evidence-based guidelines to develop Individualized Plans of Care (IPC)
• Evaluates the effectiveness of the IPC and progress against goals
• Provides or arranges for resources necessary to meet members’ psychosocial needs
• Promotes and encourages member collaboration with the primary care provider, PCT, other health care providers and social service agencies
• Facilitates PCT consultation on members’ behalf through participation in rounds, team meetings and clinical reviews, as appropriate
• Conducts face-to-face visits with selected members as appropriate
• Complies with established metrics for performance and adheres to documentation and work flow standards
• Completes documentation in the medical management information system in a timely manner and in keeping with, internal policy and accreditation standards
• Maintains HIPAA standards and confidentiality of protected health information
• Reports critical incidents
• Adheres to departmental/organizational policies and procedures
• Facilitates member communication with internal partners such Member Services
• Other duties as assigned
• Must become strongly knowledgeable in the full contractual requirements of the SCO Care Management agreement with EOHHS and CMS (D-SNP Agreements)
• Must become proficient in contracts with vendors and agencies of whom BMCHP outsources for the SCO population
• Must attend meetings at the BMCHP office(s), as requested by the Management team
• Must attend PCT meetings which may include early morning or evening meetings

Qualifications:

Education:

• Master’s Degree In Social Work

Experience Required:

• 2 years of experience working with individuals with complex medical/behavioral and/or psychosocial needs

Certification or Conditions of Employment:

• Active state licensure as a Social Worker (LICSW, LCSW)
• Pre-employment background check

Competencies, Skills, and Attributes:

• Strong oral and written communication skills
• Ability to establish and maintain effective working relationships with members, social service agencies, community resources and other members of the interdisciplinary team
• Ability to work with members to promote positive behavioral change
• Strong Motivational Interviewing skills
• Bilingual desired
• Demonstrated strong organizational and time management skills
• Able to work in a fast paced environment and multi task
• Experience with Microsoft Office application, particularly MS Outlook and MS Word and other data entry processing applications
• Knowledge of medical terminology

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

Required Skills

Required Experience