Tribal Option Medical Social Worker

Job Description

Job Description

Primary Function

The incumbent is responsible for all operational activities of the Social Services program. The incumbent is responsible for planning, organizing, directing, coordinating, and managing Social Services activities in order to assure meeting the needs of the member. The position also includes case management duties to assure clinically and financially responsible care. He / she maintains liaison with other departments, agencies, organizations, and community resources in determining appropriate resource utilization.

Job Description

• Incumbent serves as the consultant to the Tribal Option staff on all matters pertaining to social work services.
• The incumbent provides a wide range of social work activities to eligible Tribal Option members.
• The incumbent is the official liaison and will promote and facilitate a positive professional relationship between EBCI Tribal Option and other social service and human service programs in the area. This includes all Tribal, regional, community, courts, and other medical and behavioral health facilities upon request for the Native American population served.
• Services provides may include, but are not limited to the following :

Assisting members and families with discharge planning,

Education, Licensure, Certification, and Experience

Job Knowledge

20), Adult (21-64 years), and Elderly (65-+ years).

Complexity of Duties

Guidelines consist of professional standards of practice, medical policies and procedures. Must, also, comply with Compliance Plan, Utilization Review Plan, State and Federal guidelines, CMS, FPM, DHHS, PHS, and IHS regulations. These guidelines are not always specifically applicable to the individual member or situation and independent judgment is required in selecting the most appropriate guideline, and applying the intent.

Requirements are complex in that they require comprehensive skills in Social Services and Care Management and have sufficient knowledge of medicine to evaluate member care. This may involve difficult interactions with the clinical staff, case managers, care managers, and insurance payers and require maximum skills in diplomacy and judgment.

Supervision Received :

Incumbent receives administrative guidance from the Tribal Option Care Manager Supervisor. Works within the framework of regulations, policies, and procedures established by the agency, CMS, and North Carolina Division of Medical Assistance. Further guidance is received from Professional Literature, Indian Health Service Manuals, and Program Area Directives. Is expected to exercise a high degree of independent initiative and judgment in development and implementing new approaches to the delivery of quality care. Functions with a minimum of guidance and supervision. The Tribal Option Care Manager Supervisor sets the overall objectives and resources available.

Responsibility for Accuracy

The incumbent’s performance affects the health, recovery, and rehabilitation of members, and the quality of care provided. Evaluations and observations are used to modify and develop clinically and financially appropriate treatment plans. The incumbent has a

positive effect upon the recovery of the member and is responsible for the development of policies and procedures, which serve as hospital guidelines.

Contacts with Others

Contacts are with members of all ages, families, hospital personnel, community agencies, and insurance carriers. Contacts with members, families, and hospital personnel are to exchange, provide, and obtain information concerning the member’s physical and psychosocial health care problems and needs. Contacts with other health care or related disciplines and insurance carriers are for the purpose of coordination, collaboration, and consultation in meeting the member’s health care needs.

Confidential Data

The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical, and all other pertinent information that comes to his / her attention or knowledge. The Act carries both civil and criminal penalties for unlawful disclosure of records. Violations of such confidentiality shall be cause for adverse action.

Mental / Visual / Physical

Work in the various services within the Tribal Option department is mostly sedentary, yet requires walking, standing, bending, pushing, and lifting in helping members to and from beds, wheelchairs, and stretchers. These same activities are required in moving equipment and medical supplies. Will be subject to frequent interruptions requiring varied responses, which can cause distractions therefore, the incumbent must possess the ability to differentiate and prioritize many tasks at once.

Environment

Must be flexible in working hours. This position offers a hybrid work model, with the flexibility to work remotely or from the designated work space. Specific workdays and location will be determined in collaboration with the Tribal Option Care Manager Supervisor. The incumbent may occasionally be required to perform care management duties and tasks within the clinical setting. Incumbent is required to comply with Employee Health Program guidelines including current immunization status of identified communicable diseases and safety precautions are sometimes necessary, such as use of personal protective equipment as required by hospital policy. The work environment involves moderate risks of exposure to infectious disease, radiation, electrical hazards, irritant chemicals and explosive gases. Some travel is required. Infrequent overnight travel may be required for meetings or to attend training.

Customer Service

Consistently demonstrates superior customer service skills to members / customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all members / customers by seeking out opportunities to be of service.