Bilingual Field Care Manager, Social Work – LTSS, HCBS, Waiver Programs

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Oversee a designated caseload and conduct thorough assessments in members' homes, community environments, or through virtual platforms.

• Perform InterRAI Integrated Health Care assessments and pinpoint findings that necessitate RN evaluation or intervention.

• Participate in Nursing Facility Level of Care Determination activities as per your scope of practice.

• Create, execute, monitor, and adjust personalized person-centered care plans.

• Act as the primary contact for the Interdisciplinary Care Team.

• Evaluate social determinants of health and obstacles related to housing, food, transportation, safety, behavioral health, caregivers, education, finances, and access to health care.

• Facilitate access to Medicaid, Medicare, HCBS waiver, behavioral health, medical, social, housing, educational, and community services.

• Assist members in obtaining services in the least restrictive and most integrated appropriate environments.

• Provide continuous monitoring, care coordination, advocacy, and follow-up support.

• Utilize person-centered planning, motivational interviewing, trauma-informed care, and culturally responsive engagement strategies.

• Recognize and escalate urgent health, safety, abuse, neglect, exploitation, behavioral health, and service-access issues.

• Collaborate with nursing, behavioral health, primary care, specialists, waiver providers, community organizations, and caregivers.

• Ensure timely, precise, and compliant documentation in the designated electronic systems.

• Travel 75%–90% within Wayne and/or Macomb Counties, Michigan.

⛳️ Requirements

• Must be a Michigan resident and capable of traveling throughout the assigned service area, including Wayne and/or Macomb Counties.

• Proficient in English and Arabic or Chaldean Neo-Aramaic, with the ability to speak, read, and write each language independently and without assistance.

• Required: Active Michigan Social Work license in good standing (LBSW, LLMSW, or LMSW); limited-license candidates must show active progress toward full licensure.

• Minimum of 2 years of post-degree experience in social work, behavioral health, health care, care management, or community-based services.

• At least 1 year of experience supporting Home and Community-Based Services (HCBS) and/or waiver programs.

• Experience in conducting Long-Term Services and Supports (LTSS) assessments.

• Ability to evaluate functional, behavioral, environmental, and psychosocial needs to assist with eligibility determinations, service planning, risk identification, and care coordination.

• Familiarity with LTSS, HCBS, Medicaid requirements, person-centered planning principles, member rights, and least restrictive settings.

• Experience working collaboratively with interdisciplinary teams, health care providers, members, caregivers, and community organizations.

• Knowledge of community health, behavioral health, social service agencies, and local resources.

• Ability to maintain accurate, timely, and compliant documentation in alignment with organizational, state, and federal guidelines.

• Excellent verbal and written communication skills.

• Proficient in using electronic medical records, care management platforms, and health care technology applications.

• Strong computer skills, including Microsoft Word, Outlook, Excel, and web-based applications.

• Valid state driver’s license and personal vehicle liability insurance are required.

• TB screening must be completed.

• Preferred: Experience with InterRAI Integrated Health Care assessments.

• Preferred: Understanding of Nursing Facility Level of Care Determinations.

• Preferred: Experience with Medicaid, Medicare, dual-eligible populations, behavioral health, chronic conditions, disability services, or complex care management.

• Preferred: Previous experience in managed care.

• Preferred: Experience in health promotion, coaching, wellness, motivational interviewing, and trauma-informed care.

• Preferred: Fluency in English and Spanish.

🏝️ Benefits

• $5,000 sign-on bonus, subject to applicable terms and conditions.

• Bonus incentive plan based on company and/or individual performance.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Mileage reimbursement for qualifying travel.

• Self-arranged home internet with minimum requirements of 25 Mbps download and 10 Mbps upload.

• Occasional travel to Humana offices for training or meetings.