Social Worker, Utilization Management at Alignment Healthcare USA, LLC in Orange, California

Job Description:

Overview of the Role:

Alignment Health is seeking a utilization management (UM) social worker to join the utilization management team. As a social worker, you will assess the psychosocial needs of the Alignment Health catastrophic population. You will conduct telephonic outreach to members, families, caregivers, and facility staff to determine the resources that can be offered to maintain a members' needs in a safe and healthy environment. The focus will be to initiate outreach to the population that has been in an acute care setting but can extend to other levels of care. You will also work collaboratively with internal team members and other departments at the direction of the leaders of department.

If you are seeking an opportunity to learn and grow and be a part of an organization positively impacting the lives of seniors, we're looking for YOU!

Responsibilities:

• Conduct telephonic social work outreach to assigned members to assess behavior health issues, verify caregiver support, address goals-of-care concerns, identify placement barriers (financial, Medi-CAID, BH), address conservator needs, and any psycho-social areas of concerns by conducting a Social Work assessment.
• Work with the senior health plan medical director, regional medical officers, concurrent review nurse(s), and hospital team in implementing solution-focused interventions, in response to assessment findings.
• Document social work interventions and plan of care in health plan's UM platform within the same day of discussion.
• Provide appropriate interventions to optimize health and well-being. Interventions may include education, the coordination of community-based support services, as well as care coordination to mental health providers.
• Follow through with all recommendations to ensure success or to develop an alternate plan.
• Attend daily inpatient rounds and any interdisciplinary team (IDT) meetings as indicated.
• Performs duties in accordance with social work standards of practice and based on licensure scope.

Required Skills and Experience:

• Unrestricted, California Social Work license (LCSW) or master's degree in social work (MSW) required from an accredited school of social work by the Council on Social Work Education.
• Minimum 3 years' experience in care management and working with geriatric, vulnerable population.
• Experience with motivational interviewing.
• Possess strong interpersonal skills to interact effectively with multi-disciplinary team members.
• Possess strong written and verbal communication.
• Able to work independently.
• Strong computer proficiency.
• Experience with Microsoft Office: Outlook, Word, and Excel.
• Background and understanding of palliative care and hospice programs preferred.
• Spanish speaking preferred.
• Recent experience in working with a Medicare Advantage plan preferred.