Job Description:

Partners with members, their family and/or caregivers and providers so that they can self-manage their care, optimize their functional health status, have quality outcomes and use the health system appropriately. Develop, document and implement plans, which will provide the appropriate resources to address social, physical, mental, emotional, spiritual, and supportive needs.

Scope

Position reports to Healthy Connections Manager. Conducts in-home, community-based or telephonic assessments and updates to care plans

Job Essentials

Identifies members who are unable to adhere to a medical plan without additional assistance and enrolls members who are willing to engage in care management services by reviewing referrals, records and conducting appropriate assessments.
Coordinates with RN care managers as needed to address medical needs.
Coordinates with the appropriate behavioral health specialists by assessing complex mental health needs such as major depression, substance abuse disorders, PTSD or pervasive developmental disorders.
Ability to consult and/or deescalate mental health crisis issues.
Follows the applicable established model of care or care management program policies and procedures to assess, establish and maintain a plan of care which incorporates the member's individualized needs and goals within the benefit plan throughout the care management process. Ensures the plan is evidence based and consistent with goals and objectives of referral, payer contract, or established care processes.
Maintains records by reviewing case notes; logging events and progress according to applicable regulatory requirements such as NCQA, CMS and the State of Utah EQRO standards
Coordinates and facilitates communication among the member/family/representative, members of the healthcare team, and other relevant parties (e.g. other payers, Sales Team, Employer Groups, etc.) through interdisciplinary team meetings or other coordinated communication.
Contacts patient at prescribed intervals and as necessary to determine if the goals are being achieved or if they continue to be appropriate and/or realistic. Determines variances and refers patient to more comprehensive level of care if indicated.



Minimum Qualifications

Master's degree in Counseling, Marriage and Family Therapy, or Social Work. Education must be obtained from an accredited institution. Degree will be verified.

Current State Licensure as a Clinical Social Worker.

Three years of clinical work, care management, behavioral health utilization management, QA, home care, community health or occupational experience.
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Strong written, verbal and conflict resolution communication skills.
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The ability to work independently and be flexible in a rapidly changing environment.
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Current driver's license in the state caregiver resides.
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Willing to travel to member?s homes, hospital, clinic or community setting to conduct assessments
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Intermediate computer software skills in word processing and spreadsheet programs.
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Intermediate computer software skills in word processing and spreadsheet programs.

Preferred Qualifications

Experience in managed care or utilization management.
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Clinical experience in one or more of the following areas: substance abused disorders, severe persistent mental illness, PTSD.
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Experience in cognitive behavioral therapy, motivational interviewing techniques.
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Ability to work independently, demonstrates flexibility, and be self-motivated with a positive attitude.

Physical Requirements:

Interact with others requiring the employee to communicate information.
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Operate computers and other office equipment requiring the ability to move fingers and hands.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
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Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$36.18 - $55.83

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package and our commitment to diversity, equity, and inclusion .