Medical Social Worker

Job Title : Social Worker Case Manager

Location : Pasadena, CA (Remote)

Duration : 6-12+ months Contract (with possible extension)

Essential Responsibilities :

• Plans, develops, assesses, and evaluates care provided to members.
• In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care / treatment plans.
• Recommends alternative levels of care and ensures compliance with federal, state, and local requirements.
• Makes assessments of physiological and or functional status utilizing protocols.
• Initiates appropriate diagnostic testing / screening and interventions.
• Develops individualized patient / family education plan focused on self-management; delivers patient / family education specific to a disease state.
• Implements strategies to target / assess risk factors and achieve and ensure patient follow-up according to clinical and strategic measures / outcomes.
• Produces population-based reports on outcomes specific to defined patient populations.
• Develops and maintains case management policies and procedures.
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Makes referrals to appropriate community services and outside providers.
• Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies.
• Acts as liaison for outside agencies, non-plan facilities, and outside providers.
• Coordinates repatriation of patients and monitors their quality of care.