Social Work Care Manager

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Social Work Care Manager (SWCM) works collaboratively with the patient centered care team. The SWCM arranges, coordinates, monitors, evaluates and advocates for services to meet the psychosocial needs of the member. The SWCM works with the member to increase their capacity for self-management and to promote behavioral changes that facilitates short and long term linkages with necessary community, social service, medical or behavioral health resources. The population includes members with complex behavioral health diagnosis many of whom, may have had a recent incarceration.

Our Investment in You:

· Hybrid work

· Competitive salaries

· Excellent benefits

Key Functions/Responsibilities

· Utilizes motivational interviewing techniques, systems theory, change theory, acceptance and commitment approaches, patient activation and psycho-education to engage members in care management

· Supports and enhances the member’s capacity to self-manage by detecting underlying mental/behavioral health issue impacting general health

· Establishes and maintains effective working relationships and provides outreach and education to key service agencies, providers and other members of the interdisciplinary team

· Maintains flexibility and adjusts approach to the needs of the member and the team.

· Meets with members, family, supports, during office visits, at member’s home, correctional facility, half way houses, shelters or, in the community

· Assists the member, when necessary, in placing calls, completing applications, and advocating for available supports/services

· Maintains general knowledge of the most common conditions presented in the Medicaid population and is able to assess, manage and triage at risk, high needs members.

· Researches and shares community resources with members and peers.

· Contributes to the development of an individual care plan [ICP] for the member

· Collaborates with Wellsense CWA to provide in home/face to face visits to enhance member engagement and communication

· Develops and maintains community relationships providing outreach to community and state agencies and school systems

· Facilitates interdisciplinary consultation on members’ behalf through participation in rounds, team meetings and clinical reviews.

· Conducts face-to-face visits with selected members as appropriate.

· Completes documentation in the medical management information system in a timely manner and in keeping with, internal policy, accreditation and HIPPA standards.

· Regular and reliable transportation and the ability to conduct face-to-face appointments with members, providers, community and state agencies

· Perform in-person meetings with the Department of Corrections for incarcerated individuals who will be released into the community and require care management and care coordination.

· Assess and assist members transitioning from DOC to the community with social determinants of health needs.

· Assess and assist members transitioning from DOC to establish community care with a PCP, and behavioral health provider as needed to support medical and mental health needs.

· Identify educational and employment opportunities.

· Other duties as assigned.

Supervision Received

· Regularly scheduled meetings with Manager of Care Management

Qualifications

Education Required:

· Master’s Degree in Social Work, Psychology, Education, Public Health or a related field required.

Experience Required:

· 2 years of experience working with individuals with complex medical/behavioral and/or psychosocial needs

· 2 years of experience working with incarcerated individuals and/or with the Department of Corrections

Experience Preferred/Desirable:

· Active state licensure as a Social Worker or related field strongly preferred.

· License Alcohol and drug counselor

Required Licensure, Certification or Conditions of Employment:

· Pre-employment background check

Competencies, Skills, and Attributes:

· Strong oral and written communication skills

· Ability to establish and maintain effective working relationships with members, social service agencies, community resources and other members of the interdisciplinary team.

· Ability to work with members to promote positive behavioral change

· Strong Motivational Interviewing skills

· Bilingual desired

· Strong organizational and time management skills

· Ability to work in a fast paced environment

· Proficient Microsoft Office skills particularly MS Outlook and MS Word and other data entry processing applications

· Knowledge of medical terminology

Working Conditions and Physical Effort

· Regular and reliable attendance is an essential function of the position.

· Work is generally remote from home office with in person visits in the community when indicated. No or very limited physical effort required.

· No or very limited exposure to physical risk.

Compensation Range

$64,000- $93,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Required Skills


Required Experience