Under general direction Health Services Manager OP, the Medical Behavioral Social Worker assists with development of medical and behavioral health plans of care and services to patients, families and the community, for the social, emotional, psychological, economic, and environmental issues related to the entire continuum of care. Provides support and guidance to Health Services staff members related to Behavioral Health and Social Services issues. This position is expected to maintain strong working relationships with members, providers and other health plan staff.
• Supports the Health Services Department functions: medical and behavioral health utilization management with inpatient admissions and discharge planning, case/population and disease management (Whole Person Health Support Program) with strong emphasis on behavioral health and substance abuse service coordination
• Provides consultation with multi-disciplinary team members to facilitate communication with providers, members and their families
• Develops professional relationships with, and knowledge of aftercare resources, including their scope and referral process requirements to improve Member safety in the community (i.e., State and regional forms of assistance, housing, and entitlements)
• Creates and maintains/updates a community resource list
• Participates in the development of the Member’s health care plan by maintaining a thorough and current understanding of Sendero Health Plan’s criteria as well as Texas Department of State Health Services Resiliency and Disease Management Utilization Management Program Manual and Member’s benefits
• Performs all job expectations and standards in an accurate and timely manner.
• Maintains proper documentation of services within ethical, confidentiality, and risk-management guidelines
• Supports and encourages consistent levels of performance by communicating clearly (in supervision or whenever indicated) the standards and goals of the Social Work component within the Health Services department and/or entire organization
• Formulates a Psychosocial Assessment comprising current information (dynamics, ability to cope with hospitalization, loss of functional levels, life changes dictated by illness, supports, and financial resources) in order to:
o Share with other multi-disciplinary members, information that will enhance effectiveness and outcome of plan-of-care.
o Identify barriers to successful health maintenance for Members.
o Identify risk of onset or prior existence of psychiatric diagnosis, or substance abuse.
o Make appropriate recommendations/referrals.
• Prevents communication break-downs between members, families and providers, balancing advocacy and staff member role requirements
• Identifies probability of child, adult/elder abuse/neglect/exploitation or domestic violence, and report to designated agencies (CPS, APS), and law enforcement
• Provides support as a resource to members/families confronting simultaneously illness and/or divorce, custody, and adoption issues
• Readily identifies and provides crisis intervention, counseling, and emotional support and referral where and when needed
• Identifies root-causes of frequent behavioral health re-admissions and addresses them within the scope of Social Work (i.e., culturally-based perceptions of illness and health, ill-understood nature of life-changes secondary to disease, lack of resources)
• Incorporates independent thinking, judgment and initiative when interfacing with physicians, providers, nurses, and other health care professionals as well as Members
• Handles confidential and time sensitive materials including clinical information that is subject to HIPAA requirement
• Utilizes computer to perform word processing and data entry, creating and maintain databases, conduct online research, format letters, reports and other information, and composes routine correspondence
• Performs other duties as assigned
• Attendance is crucial to position
• Working knowledge of current Medicare/Medicaid guidelines, Community agencies/resources, financial programs,
i.e., TANF/SSI and familiarity with principles of growth and development
• Experience with crisis intervention with largely pediatric populations
• Strong interpersonal skills with the ability to interface effective both externally and internally with a wide range of people
• Strong problem solving skills with effective follow through
• Strong listening, verbal, presentation and written communication skills
• Organizes work and uses time efficiently. Takes the initiative to find additional work during slow or downtimes. Fully participates in maintaining a positive team environment that is conducive to customer satisfaction
• Builds trust among co-workers, focusing on accomplishing the organization’s mission and goals
• Recommends innovative ways of doing work more efficiently and effectively
• Ability to work with multidisciplinary staff
• Ability to apply independent discretion and judgment in handling sensitive and confidential communications and materials
• Ability to handle detail and constantly shift between competing priorities
• Ability to perform moderately complex operations using Microsoft Office Suite and skill in using the internet
MINIMUM EDUCATION: Bachelor’s Degree in Social Work from an accredited school of Social Work
MINIMUM EXPERIENCE: A minimum of three years’ experience in medical social work is required
PREFERRED EXPERIENCE: Previous experience in a managed care environment; Bilingual skills (English and Spanish) highly
desirable; Experience in behavioral health is required; Experience as a behavioral health counselor/therapist is desirable and previous experience with multi-cultural communities is desirable.
REQUIRED CERTIFICATIONS/LICENSURE: Must have a current LBSW or higher level Social Worker Licensure in the State of