Case Manager

Client: Direct Health Care Client

Job Title: Social Worker Case Manager

Location: Pasadena, CA- The first day will be onsite training. Once training is complete, worker will be working fully remote.

Duration: 3-6+ Months - (Possible extn/conversation)

Pay Rate Range: $30/hr to $35/hr on w2

Note: Master degree in Social worker or LCSW is required for this role.

Job Description:

• 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.
• Develops and maintains case management policies and procedures.
• Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care.
• Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
• Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
• Arranges and monitors follow-up appointments
• Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy).
• Makes referrals to appropriate community services and outside providers.
• Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
• Develops and collects data; trends utilization of health care resources.
• 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.