Case Manager Social Work

Job Summary:

MedStar Health is looking for a Case Manager Social Work to join our MedStar Health Family Choice (MFC) team! We are looking for a licensed Social Worker with the ability to create, edit and analyze in Microsoft office (Word, Excel, and PowerPoint).

The Case Manager Social Work will coordinate, negotiate, procure and manage care of our members/enrollees to facilitate cost effective care to the members/enrollees' satisfaction. Facilitates the continuum of care, works collaboratively with interdisciplinary staff, internal and external to the organization.

Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move!

Primary Duties:

• Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care. Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical, psychiatric, psychosocial, social determinant of health (SDOH) needs, and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.

• Maintains working knowledge and collaborative relationships with District of Columbia and/or Maryland agencies and resources. Attends and participates in MFC staff meetings, Clinical Operations department meetings, Special Needs Forums, work groups, District/ community agencies meetings, etc., as assigned. Provides input, completes assignments, and shares new findings with other staff.

• Attends court ordered hearings and helps with coordinating needed care. Identifies and reports potential coordination of benefits, subrogation, third party liability, worker's compensation cases, etc. Identifies quality, risk, or utilization issues to appropriate MedStar personnel.

• Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-certification requests, as appropriate. Interfaces with the community for home visits or group meetings.

• Maintains knowledge of MFC benefits and enrollment issues to accurately coordinate services. Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policies and workflows. Provides ACD telephone coverage and processes calls related to PCP (Primary Care Physicians) and provider questions, eligibility and benefits, transportation, and authorization issues. Works to actively develop and/or manage assigned case management programs, such as HIV, and behavioral health conditions as appropriate for the population served. Keeps informed about disease processes, treatment modalities, and resources.

Qualifications:

• Master's degree in social work.

• 2 years recent care/case management experience.

• 3-4 years Diverse clinical experience.

• 3-4 years behavioral health per population served, if applicable.

• Valid MSW (Master of Social Work) license in the District of Columbia and/or State of Maryland based on work location(s) or (LICSW (Licensed Independent Clinical Social Worker) in the District of Columbia and/or State of Maryland based on work location(s) or LCSW (License Clinical Social Worker) in the District of Columbia and/or State of Maryland based on work location(s) or Valid Licensed Graduate Social Worker (LGSW) in the District of Columbia and/or State of Maryland based on work location(s).