Social Worker Care Coordinator, Medicare (Mostly Remote)

Overview Provides care management through a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet member's health needs through communication and available resources, while promoting quality cost-effective outcomes. Maintains members in the most independent living situation possible; ensures consistent care along entire health care continuum by assessing and closely monitoring members' needs and status. Provides care management services and authorizes / coordinates services within a capitated managed care system. Communicates and collaborates with primary care practitioners, interdisciplinary team and family members. What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities What You Will Do Assesses, plans and provides intensive and continuous care management across acute, home, and long-term care settings. Develops and negotiates care plans with members, families and physicians. Assesses a person’s living condition / situation, cultural influences, and functioning to identify the individual’s needs; develops a comprehensive care plan that addresses those needs. Assesses an enrollee’s eligibility for Program services based on his or her health, medical, financial, legal and psychosocial status, initially and on an ongoing basis. Plans specific objectives, goals and actions designed to meet the member’s needs as identified in the assessment process that are action-oriented, time-specific and cost effective. Implements specific care management activities and or interventions that lead to accomplishing the goals set forth in the plan of care. Coordinates, facilitates and arranges for long term care services in the home and community-based sites, such as adult day care, nursing homes, rehab facilities, etc. Arranges for on-going nursing care, service authorization and periodic assessment. Collaborates and negotiates with interdisciplinary teams, health care providers, family members, and third party payors, as applicable, across all health settings to ensure optimum delivery and coordination of services to members. Monitors care management activities, services, and members’ responses to interventions, to determine the effectiveness of the plan of care and the utilization of services. Evaluates the effectiveness of the plan of care in reaching desired outcomes and goals; makes modifications or changes in the plan of care as needed. Identifies trends and needs of groups in the community and plans interventions based on these identified needs. Provides care management services across sites and collaborates with appropriate facility discharge planner and / or HCC when members are transitioned between settings. Manages expenditures to ensure effective use of covered services within a capitated rate. Fiscally responsible in providing services based on members’ needs. Provides social work services in accordance with NASW code of ethics, VNS Health policies, practices, and procedures. Participates in outreach activities to promote knowledge of the Program and its services and to coordinate Program activities with outside community agencies and health care providers (e.g., community health screening, In Services). Participates in the development of programs to meet the specialized needs of this selected patient population. Documents services in accordance with Health Plans Community Care standards and Managed Long Term Care (MLTC) and Licensed Home Care Services Agency (LHCSA) regulations. Qualifications Licenses and Certifications : License and current registration to practice as a Licensed Social Worker in New York State preferred Education : Master's Degree in Social Work required Case Management Certification preferred Work Experience : Minimum of three years of Social Work experience required Minimum of two years in a case management and / or community based environment preferred Bilingual skills may be required, as determined by operational needs. Clinical expertise in geriatrics, Long Term care and Managed care experience preferred Pay Range USD $70,200.00 - USD $87,700.00 / Yr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24 / 7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.