Description: Under the direction of the Case Management Supervisor and in coordination with the Administrative Director of Health Services, the CM Social Worker will plan and implement medical social service delivery programs, promote coordination, continuity of care, and quality management in support of KHS members. The Social Worker will work, in conjunction with the Kern Health Systems (KHS) based Case Management team, to evaluate the appropriate care setting and facilitate a safe discharge plan using established criteria and Plan benefit guidelines as outlined within the discharge plan of the physician(s). The Social Worker will create and review reports to identify inappropriate use of services, to identify the need for a corrective action plan and work with the member to assist in compliance with that plan.
This position is responsible for assigned social work case management functions for a Knox-Keene licensed health maintenance organization (HMO). The primary duty of the CM Social Worker is to identify members that are displaying an inappropriate usage of services reflective of abuse, lack of compliance to medical or pharmaceutical instructions or self-destructive habits. Coordinate with these members and the memberís PCP in an effort to provide better medical management and to track and gauge the effectiveness of that effort.
Requirements: Masters of Social Work degree from an accredited college/university required. LCSW preferred. Two (2) years of experience in the Social Worker field, preferably a background in the medical social work. Demonstrated experience in social work including interviews, assessments, problem identification/resolution, appropriate documentation and crisis intervention. ** Bilingual Spanish/English (Tier I) Certificate Required. Excellent written, verbal and interpersonal communication skills required. Applicants should be able to demonstrate knowledge and experience of managed care systems. Have demonstrated skills in coordination and problem solving with members and providers. Possession of valid driverís license and proof of State required auto liability insurance. Required Travel Up to 10%.
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.