Universal American

Social Worker - Transitional Care

Job Title: Social Worker - Transitional Care

Job ID: 816023

Begin Date: 8/15/14

Duration

Location: Houston, TX

Other Location

Description: Do you love healthcare and helping others? Do you excel at teaching members about their health and well-being? Are you looking for an opportunity to empower others, while maintaining a strong work/life balance? Universal American is the place for you!

Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.

We have an exciting opportunity for a Health Services Social Worker in the Houston area. This position will be based remotely from a home office and travel will be required 50% of the time.

The Health Services Social Worker is a licensed (Master’s or Bachelor’s degree) clinician with strong care management and medical social work knowledge within the managed care industry. The Social Worker is responsible for the assessment, planning implementation, coordination, monitoring, and evaluation of the Health Plan’s membership with regard to behavioral health and psycho/social issues. This position also assists management with training and achieving department goals.

Responsibilities:
• Coordinates service management activities with the primary care provider, UM/CM staff, medical case managers, mental health professionals, chemical dependency treatment providers, public agencies, and other providers as required.
• Documents all findings, contracts and interventions per protocol.
• Coordinates necessary services with participating ancillary service providers and public agencies as appropriate.
• Maintains regular communication with state agencies, healthcare individuals and support systems to promote efficient and well-coordinated quality care.
• Develops service management recommendations consistent with the preferences of member and family and incorporating care goals based on identified needs and required services with a significant focus on psychosocial concerns.
• Determines appropriate frequency and type of contacts to meet care plan goals based on assessment.
• Care coordination includes ongoing assessment of health needs, individualized care plans, implementation, monitoring and evaluation of outcomes.
• Arranges for health care services within the scope of available benefits using sound medical and financial management.
• Regularly reviews service plans for continuity and makes plan modifications.
• Maintains active revolving caseload of varying acuity level, is primary resource for members with behavioral health issues.
• Provides support to Optum Health staff regarding mental health or chemical dependency issues with members. Provides leadership and direction to ensure appropriate follow-through, reporting and documentation. Serves as a team member when social service needs are identified.
• Works with the Care Managers to maintain and ensure accuracy of information for all cases.
• Establishes and maintains professional rapport with providers, members, public agencies, and other case managers involved in the members care.
• Attends departmental meetings.
• Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
• And all other duties assigned by the manager and/or supervisor

Required Skills:
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
• Organizational skills with the ability to handle multiple tasks and/or projects at one time
• Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
• Analytical and interpretation skills including departmental, utilization, financial and operations data
• Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
• Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
• Problem solving skills with the ability to look for root causes and implementable, workable solutions
• Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
• Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience:
• Bachelor’s Degree in Social Work, Master’s preferred
• Current unrestricted license
• Minimum of 2 years of Social Work experience in a setting that includes managing medical, mental health and CD care and services
• Minimum 1 year Public Health experience, preferred
• Knowledge of social support systems and resources is preferred
• Certified Case Manager (CCM) preferred or eligible to sit for exam
• Knowledge of statistics, data collection, analysis, and data presentation
• Knowledge of utilization management techniques
• Knowledge of applicable state, federal and third party regulations and standards
• Knowledge of Medicare products and regulations for HMO and PPO
• Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce

Required Skills: • Bachelor’s Degree in Social Work, Master’s preferred
• Current unrestricted license
• Minimum of 2 years of Social Work experience in a setting that includes managing medical, mental health and CD care and services
• Minimum 1 year Public Health experience, preferred
• Knowledge of social support systems and resources is preferred
• Certified Case Manager (CCM) preferred or eligible to sit for exam
• Knowledge of statistics, data collection, analysis, and data presentation
• Knowledge of utilization management techniques
• Knowledge of applicable state, federal and third party regulations and standards
• Knowledge of Medicare products and regulations for HMO and PPO
• Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

Openings: 1

Social Worker - Transitional Care

Option 1: Create a New Profile

Option 2: Login and Apply