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Social Worker DEPARTMENT
Care N’ Care Insurance Company of North Carolina, Inc. COST CENTER
VP, Utilization Management
DATE CREATED / REVISED
November 2, 2020 SUPERVISES OTHERS
This Social Worker provides a second tier of social work support to the HealthTeam Advantage (HTA) care management program. Through collaboration, research, engagement and by utilizing the skills and knowledge base of the bachelor’s prepared social worker, our patients are served far more efficiently and effectively. The BSW will work as a team member along with other THN disciplines; to include RN’s, CMA’s, Pharmacists, Pharmacy Techs, and LCSW’s to support, prevent and eliminate barriers for our patients. The BSW will be responsible for providing community resource and transportation support to the HTA care management staff. This position requires strong organizational skills in order to multi-task and prioritize referrals, assignments and requests. Professionalism and effective customer service is key when interacting with leaders in the organization, as well as internal and external customers. Serves as an assertive advocate and liaison between the patient, insurance companies, Social Security Administration, and community service organizations. This position requires confidentiality, discretion and shared duties among the team.
Education Bachelor of Social Work from a program accredited by the Council on Social Work Education N/A
Regulatory N/A N/A
Experience • One to two (1 to 2) years of recent inpatient or outpatient experience • Community experience. Equivalent combination of education and experience may be considered.
MAJOR WORK ACTIVITIES (MWA’S) WEIGHT (%)
1 1. Manages Community Resources
Identifies and accesses community resources to optimize effective and efficient member care outcomes in collaboration with other members of the multidisciplinary team. Links members to community resources. Maintains a comprehensive, up-to-date filing system for agency brochures/lists, correspondence, records and administrative data with appropriate indexing so that documents can be retrieved easily by anyone searching for the information. Assists CM team, particularly new staff, in identifying community resources to benefit members and families, and assists with completion of referrals as requested. Works with organizational and/or community leadership to identify the need for and develop resources needed to achieve optimal outcomes.
2 2. Coordinates Transportation Services
Receives transportation referrals from the HTA and THN team, discerns per plan the appropriate resources the member may need. Communicates with patient and CM teammates the transportation services the patient qualifies for and the necessary follow up per member needs and actions taken. Maintains appropriate documentation according to transportation workflow. Demonstrates initiative in tracking amount and use of supplies and notifies leadership proactively when supplies needing leadership intervention (bus tickets, etc.) are running low. – as applicable. 30
3 3. Assist Clinical Social Worker with Placement into Facilities
Guides / Assists with facility placement. Facilitates the completion of FL-2 forms. Contacts assisted living or skilled nursing facilities to determine bed availability. Verifies members coverage/benefits/in-network providers, and to obtain prior authorization when requested. Arranges appropriate transportation for discharge as directed. Ensures departmental leadership are aware of potential barriers to efficient, effective completion of tasks by self and by Clinical Social Workers (system delays, etc.) Proactively ensures appropriate utilization of resources and achievement of optimal patient outcomes in compliance with regulatory requirements. 15
4 4. Advocates for patients, family members, organization and profession.
Advocates for members, family members and organization; contributes to the professional development of self and others. Educates other disciplines about the importance of communicating appropriate information to social work staff, and intervenes when appropriate. Ensures members and family members are actively informed of and participating in the care process and are able to make informed decisions about care. Advocates for members’ cultural and religious beliefs and value systems, and ensures that this information is communicated to others on the healthcare team so that they are incorporated into the care plan; educates healthcare team about the impact of these factors on patients’ healthcare decision-making and health and wellness outcomes. Assists with orientation and mentoring new staff and students as requested. Adheres to the National Association of Social Workers Code of Ethics. 15
5 5. Participates in quality improvement as requested
Participates in quality improvement. Participates in data collection in accordance with departmental policies and procedures, and with accuracy and within requested timeframes. Reviews, interprets and applies clinical and financial data relevant to assigned patient populations.
Performs other duties as assigned. 10
KNOWLEDGE, SKILLS AND ABILITIES
Knowledge Builds constructive working relationships characterized by a high level of acceptance, cooperation and collaborating throughout the health care community to benefit the member.
Skills Adapt to changing business needs, priorities, and work responsibilities.
Takes personal responsibility for the quality and timeliness of work and achieves results with little oversight. Microsoft word, excel and power point
Abilities Strong telephonic communication – communicates in a clear and concise manner. Uses appropriate grammar, pronunciation and tone to enhance understanding. Tailors communication style to needs of the recipient.
Testing/Competency 0 Yes 1 No (Must satisfactorily complete required testing)
X IF YES
Sedentary Work • Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or;
• a negligible amount of force frequently (1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
• Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X
Light Work • Exerting up to 20 pounds of force occasionally (up to 1/3 of the time), and/or;
• up to 10 pounds of force frequently (1/3 to 2/3 of the time), and/or:
• a negligible amount of force constantly (2/3 or more of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
• Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible
Medium Work • Exerting 20 to 50 pounds of force occasionally (up to 1/3 of the time), and/or;
• 10 to 25 pounds of force frequently (1/3 to 2/3 of the time), and/or
• Greater than negligible up to 10 pounds of force constantly (2/3 or more of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
Heavy Work • Exerting 50 to 100 pounds of force occasionally (up to 1/3 of the time), and/or;
• 25 to 50 pounds of force frequently (1/3 to 2/3 of the time), and/or;
• 10 to 20 pounds of force constantly (2/3 or more of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
Very Heavy Work • Exerting in excess of 100 pounds of force occasionally (up to 1/3 of the time), and/or;
• in excess of 50 pounds of force frequently (1/3 to 2/3 of the time), and/or;
• in excess of 20 pounds of force constantly (2/3 or more of the time) to lift, carry, push, pull, or otherwise move objects, including the human body.
Time: Full time
Updated: 11/5/2020 1:14:14 PM