SNP Social Worker – Peak

This is a fully remote position, open to applicants in Ohio, +4 more states.

📋 Description

• Engage in activities concerning the establishment, execution, oversight, and delegation of care management programs.

• Support compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements.

• Implement psychological, social, and economic care management interventions for members experiencing severe or persistent mental or emotional disorders.

• Conduct comprehensive telephonic behavioral health assessments of members’ environmental, behavioral, psychological, economic, and social factors.

• Collaborate with the assigned care manager to create individualized and culturally sensitive care plans, identifying issues, interventions, barriers, and objectives.

• Carry out telephonic re-assessments, revise care plans, and evaluate the effectiveness of members’ care strategies.

• Serve as a member of the Interdisciplinary Care Team (ICT) for individuals with Social Determinants of Health (SDOH) and behavioral health needs, participating in ICT meetings as necessary.

• Identify early signs of member decompensation that necessitate immediate case management intervention, promoting and encouraging adherence to treatment plans.

• Act as an additional contact during transitions of care.

• Co-manage member cases alongside the care manager to address psycho-social, economic, and cultural factors impacting members’ care requirements.

• Function as a primary socio-economic resource for the D-SNP Care Management Team.

• Document member cases accurately and promptly to ensure the coordination of care needs.

• Comply with all CMS, Code of Federal Regulations, and local/state/national regulatory requirements and guidelines, including those specified within the MOC.

• Collaborate with all members of the interdisciplinary care team to facilitate necessary community resource assistance for members with identified needs.

• Screen, identify, diagnose, treat, and manage mental health and/or substance abuse issues in patients and their family members.

• Possess knowledge of hospital, medical center, and/or health system resources to support patient care needs.

• Maintain familiarity with community agencies and resources, serving as a liaison between these entities and the healthcare system.

• Collaborate on appropriate resource and financial management, which may include financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.

⛳️ Requirements

• Master’s Degree in Social Work or a related field.

• Current social worker licensure for the relevant service area: WV: Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW), or Licensed Independent Social Worker (LICSW) through the West Virginia Board of Social Work; PA: Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists, and Professional Counselors; OH: Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Independent Social Worker-Supervision (LISW-S) through the Ohio Board of Social Work; MD: Licensed Masters Social Worker (LMSW), Licensed Certified Social Worker (LCSW), or Licensed Certified Social Worker-Clinical (LISW-C) through the Maryland Board of Social Work.

• A minimum of two (2) years of clinical experience.

• LICSW certification in West Virginia is preferred.

• Experience managing Medicare and/or Medicaid populations is preferred.

• A minimum of two (2) years of Behavioral Health experience is preferred.

🏝️ Benefits

• Standard office environment.

• Some travel may be required for offsite meetings.