Job description
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MMM Holdings, LLC.
Job Description
POSITION TITLE: Social Work Case Manager
POSITION DESCRIPTION
The primary goal of the Social Work Case Manager (SWCM) is to optimize members’ health care and delivery of care experience with expected cost savings while improving quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. SWCM is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver. This will be accomplished through in field work in member’s homes, facilities, provider offices and community resources. The SWCM serves as member’s advocate and accompanies the member throughout their care journey in the field.
SWCM provides support to individuals, families, and groups with the psychosocial needed to cope with chronic, acute, or terminal illnesses. Services include advising family care givers, providing patient education and counseling, and making referrals for other services. May also provide care and case management or interventions designed to promote health, prevent disease, address barriers to access to healthcare and improve member quality of life and health outcomes.
SWCM is monitored and assessed based on value added to improved health status of member. That includes, but it’s not limited to their disease management, physical and behavioral, medication adherence, and utilization of emergency services, hospitalizations and avoidable complications. SWCM primary role is to support members in need and problem solves issues in a beneficial manner for the member and Plan. The support is comprehensive and includes clinical, social, financial, environmental and safety aspects.
This is a hand on, involved, predominately field based position and will require travel within MMM Holdings, service area to decrease the impact of the Social Determinants of Health in the its population.
RESPONSIBILITIES
Be accountable to manage the clients, who are in need of medical and mental health, elderly care, substance abuse, or social welfare related services Determine the level of client’s risk and take appropriate steps Keeping up to date with the laws related the program functions Provide services in the appropriate environment setting for the member. Make own decisions and take action independently without consultation of the supervisor except in ordinary situations. Manage the caseload appropriately including:
Maintaining the establish workload
Performing closure process and follow up cases in a timely manner
Self-monitoring
Establish self-strategies to decrease adverse operational impact in workload management.
Appropriate scheduling of activities such as visits or administrative tasks
Works independently in the field. Establishes priorities, schedules task completion and meets scheduled deadlines as evidenced by timeliness of reports. Make referrals and provide assessment, follow-up intervention, and case management. Provides care and intervention in various environments of where member is, home, clinic, hospitals, ER, IPA/PCP office, among others. Carry a corporative cell phone and be available to members under his/her interventions and to the management team for urgent matters. Demonstrates expertise in coordinating and managing aspects of the action and/or care plan in the program. Oversee and participate in the assessment of patients for admission to program Assess members and/or appropriate representative in a biopsychosocial perspective and perform interventions with holistic approach. Design a care planning and/or review process for conduction when feasible. Performs case discussions with member’s healthcare providers and collaterals as applicable. Participates in the care team members for conducting a care plan. Participates in case rounds as established to ensure that patient care program functions are appropriate and that patient needs are being met. Communicate established care plan to members and member’s usual practitioner as established in policies and procedures. Ensures community referral development appropriately based on members identified needs and available resources. Develops and maintains a successful and satisfactory inquiry/call management providing appropriate solutions. Visit community agencies or resources to provide follow up for services, facilitate the development and/or update of a Community Data Bank or establish alliances for member’s benefits in coordination of care.
Visits may include member’s home, family members’ home, medical offices, hospitals, MMM regional offices, community organizations (private and public), clinics, and urgent care centers, IPAs, among others related to the member’s health care and/or wellbeing.
Document agreements with community agencies and programs that will ensure continuity of care and the proper use of community resources. Makes or ensures contacts with referral sources for updates and/or case discussions Consults with patient and their family members, as necessary, for purpose of solving complaints dealing with patient care. Serves in a resource capacity to other area agencies both public and private, regarding services available and interprets the program and its services to the general public, staff members, other professionals, and families of patients. Interacts with families and individuals to assess their requirements and/or needs, and find social services programs that would assist them. Coordinating the integration of case management or social services functions into the client care, home planning, and discharge processes. Reports social, behavioral and/or clinical emergencies to the corresponding agency (ies) immediately. Provide member’s family counselling and support. Acting as patient advocate, investigating, and reporting adverse occurrences. Evaluating quality of healthcare provided and patient satisfaction Completes the case management process as established in policies and procedures and perform an appropriate case closure. This process may include:
Interventions completition or addressing
Current enrollment status validation
Review admission status
Status communication to members, representative and usual practitioners.
Screen for other internal clinical programs and perform referrals.
Perform other duties and special projects upon request Social Services Department.
EDUCATION AND EXPERIENCE
- Master Degree in Social Work from a school of social work fully accredited by the Council on Social Work Education (CSWE).
- Permanent license
- Current Membership of the PR College of Social Work Professionals
- At least three (3) years field experience, with strong healthcare settings background preferred.
- Experience in managed care, home care or community health setting preferred.
- Bilingual in Spanish/ English, preferred
SKILLS, knowledge and abilities
- Ability to understand medical terminology.
- PC skills, including but not limited to Microsoft Office
- Ability to work in the field at least 60% of the time
- Available for traveling across the Island
- Receptive for training or retraining purpose
- Ability to accept constructive recommendations
- Critical judgment for decision making
- Ability on problem solving
- Knowledge in community available services
- Ability to present concise, accurate, and meaningful reports both verbally and in writing.
- Ability to handle confidential data discreetly.
- Ability to work with minimum supervision
- Ability to manage different social problems and locations for solutions
- Knowledge of legal, ethical, and professional standards applicable to social work practice.
- Time management skills
- Available to move into work stations or locations
- Self-motivated
Maintains professional and positive interaction with physicians, offices, members and MCO/MSO staff. Ability to make Care presentations in a clear and concise format, ensuring mutual understanding through discussion, questions and feedback; and presents self in professional appearance.
Customer Service
Meets internal and external customer expectations by demonstrating understanding of customer/member needs to ensure effective delivery of a solution, product, or service that best fits their needs. Must be empathetic and assertive during client interventions.
Effectively and efficiently uses time and resources to achieve work-related goals, organizing activities according to priority and the need for coordination and cooperation with others. Functions at a high level in fast paced environment.Able to multi-task and meet deadlines
Critical Thinking
Ability to evaluate information and situations in order to make independent decisions and to identify critical issues
Problem
Resolution/Decision-Making
Applies considered judgments to make decisions within scope of professional practice and assigned job duties, based on critical analysis and evaluation of the situation, the options, and their implications to elicit a positive outcome. Promotes dialogue to seek resolution of conflicts or problems with others.
Takes responsibility for assigned work, following through to ensure goals are met or exceeded. Takes responsibility for decisions and/or actions in the job.
Responsiveness to Change
Demonstrates openness to new ideas and ways of working; adapts to changing needs and situations; approaches issues with an openness to change and a willingness to pursue different approaches to achieve a positive outcome.
Works cooperatively and collaboratively with others, contributes to the "team" in its broadest sense; encourage participation, commitment, and an active contribution from him/her and others in the pursuit of common goals. Actively seeks ways to apply knowledge and skills to help others.
Proficient key boarding skills.Knowledge of MS office including Word and Excel. Information and respond to questions from groups of managers, providers, members, and the general public.
Reasoning Ability
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Interpersonal Relations
Communicate orally with customers, clients, or the public in group settings to give instructions, share information and respond to questions. Produce written documents with clearly organized thoughts using proper Spanish/English sentence construction, punctuation, and grammar. Work safely without presenting a direct threat to self or others. Work cooperatively with other employees and the public.
Result Oriented
Ability to be productive in a fast-paced, demanding, and diverse work environment; time management skills a must. Able to work independently and in team environment. Innovative problem solving skills, self-motivated and directed. Must have strong leadership skills.
Demonstrated PC skills, including but not limited to Microsoft Office, word processing/spreadsheet/database and graphics applications strongly preferred.
Physical and mental demand
Requires sitting and standing associated with a normal office environment. Regularly talks and hears. This position requires that weight be lifted or force be exerted up to 10 pounds.
Environmental and working condition
Must of the time require the use of personal vehicle. Individuals must be physically capable of operating the vehicles safely; possess valid driver’s license and have an acceptable driving record. A flexible schedule which could involve evening and weekend work. Normal office environment, the noise is typically moderate. Drives long distance.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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