Job Description
Department(s): Case Management
Reports to: Manager, Case Management
FLSA status: Non-Exempt
Salary Grade: J - $65,000 - $106,106


About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health.

About the Position

The Social Worker role is a critical part of the Case Management team. The incumbent will serve as the primary contact for Social Service Agency (eligibility), Behavioral Health, community partners, Regional Center of Orange County (RCOC), Orange County Public Guardian (OCPG) and other organizations as appropriate. The incumbent will complete assessments and use this information to route high risk members to complex case managers. The incumbent will act as a resource for Case Managers, health networks, Customer Service and community partners to address medical, behavioral and psychosocial concerns. The incumbent will also provide assistance to out-of-county providers to ensure continuity of care. The Social Worker will act as a consultative liaison to assist members, health networks and community agencies to coordinate services covered by Medi-Cal.


Duties & Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Anticipates needs for members at risk of transition of care and proactively supports reducing the risk of requiring medical and behavioral health treatment at a higher level.
• Acts as an integral part of the team providing verbal and written support interdepartmentally as well as providing support to community agencies, health networks and social services.
• Collaborates and communicates with the member, family, conservators, significant other(s), physicians, health networks and other health care providers to support and accomplish goals identified.
• Accepts referrals for case management and serves as a liaison to community agencies and organizations.
• Provides social work consultation and education to members, families and providers. Acts as an advocate to assist in the coordination of the member's identified psychosocial needs, utilizing community resources and support when appropriate.
• Participates in pro-active identification of patients appropriate for care management. Initiates appropriate follow-up and the development of assessments, education, resource planning and coordination of services for members accepting case management.
• Maintains documentation of case management plans/interventions and statistics required that impact case management, quality and care settings to best meet the member's needs.
• Develops and maintains a network of current community resources and services where members can be referred to for assistance.
• Collects and analyzes data from initial, annual or updated health risk assessments, stratification tools, outcome measures and internal and external reports in order to identify trends, individual issues, problems and resources that are most appropriate to meet member's needs.
• Assists with the establishment of measurable standards and reporting for monitoring processes and makes recommendations for areas of improvement.
• Performs regular review of cases and events to identify patterns and trends to ensure the department's compliance with Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards.
• Serves as a liaison and resource for internal partners including but not limited to: CalOptima Health's Customer Service, Utilization Management, Case Management and external partners including agencies such as Orange County Social Services, Long Term Services and Supports (LTSS), RCOC, OCPG and California Child Services (CCS).
• Participates in Interdisciplinary Care Teams (ICT's) and assists with making recommendations for cases and follow-ups with recommended interventions as discussed.
• Completes other projects and duties as assigned.

Experience & Education:

• Bachelor's degree in Behavioral Sciences or related field required.
• 5 years of experience working with Medi-Cal members required.
• Experience in working with members in a multidisciplinary care team setting.
• Have access to means of transportation for work away from the primary office approximately 20% of the time.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Master's degree in Social Work or related field.

Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of job, employee may be required to move about the organization. Must also be able to reach with hands and arms and must be able to lift and carry up to 25 pounds to transport laptop and other material as needed. Employee must be able to communicate, particularly for regular phone use and face-to-face interaction. Employee must have means of transportation to and from various locations during a work day.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. Off-site visit environment is equivalent to a client's home.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4279

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