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Health Plan Social Work Care Coordinator - Denver Health Medical Plan (Must Be A Colorado Resident)
Health Plan Social Work Care Coordinator - Denver Health Medical Plan (Must Be A Colorado Resident)Denver Health • Denver, CO, United States
Health Plan Social Work Care Coordinator - Denver Health Medical Plan (Must Be A Colorado Resident)

Health Plan Social Work Care Coordinator - Denver Health Medical Plan (Must Be A Colorado Resident)

Denver Health • Denver, CO, United States
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We are recruiting for a motivated Health Plan Social Work Care Coordinator - Denver Health Medical Plan (Must Be A Colorado Resident) to join our team!

We are here for life's journey.

Where is your life journey taking you?

Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all :

Humanity in action, Triumph in hardship, Transformation in health.

Department

Managed Care Administration

  • Must Be A Colorado Resident

Job Summary

Under general supervision, the Health Plan Social Work Care Coordinator (SWCC) is responsible for facilitating and coordinating the care delivered to an assigned group of members using multidisciplinary and member / family collaboration to ensure quality and cost effective outcomes are delivered within appropriate care coordination parameters. Coordination involves assessment of care needs, planning, support, and evaluation of member care and related outcomes. Activities to be performed are screening and assessment of medical, behavioral health and social determinants needs and gaps in care, collaboration with the Member to develop a care plan with SMART goals, scheduled outreach to support member in achieving their goals and supporting the Members self-efficacy to navigate systems. SWCC communicates closely with the Member's care team inclusive of : the Member, designated health representatives, primary care provider, behavioral health providers and other care coordinators involved with the Member's care. Encounters occur face to face, telephonically, and electronically with members in clinic and in other community-based settings.

Position is an active contributor in the development of systems (e.g. work flows, clinical pathways, assessments) to improve the care of assigned member populations. Helps ensure compliance with state, federal and third party payor requirements.

Essential Functions :

Utilizes Care Coordination Processes :

  • Systematically collects focused data relating health needs and concerns of member, group, or population.
  • Establishes and maintains member-centered relationships.
  • Analyzes assessment data to determine opportunities for health promotion, health maintenance or health related problem needs and statements.
  • Identifies and executes evidence-based interventions to support the Member in achieving their health goals.
  • Identifies and works towards expected outcomes in a plan of care individualized for a specific member, group or population.
  • In collaboration with the Member, develops a care plan that identifies strategies and alternatives to attain expected outcomes. Utilizes competent, evidence based, telephone encounters and electronic communications according to regulatory requirements and standards, as well organizational policies and procedures.
  • Conducts systematic evaluation of outcomes of care coordination in relation to structures and processes prescribed by plan.
  • Documents in readable, understandable language according to professional, regulatory, and agency standards.
  • Documents and disseminates results of care to member, caregivers, and others involved in the care or situation, as appropriate, in accordance with contractual requirements, state and federal laws, regulatory requirements, and Denver Health policy.

    • (25%)

    Provide Care Coordination Services :

  • Coordinates the delivery of care within the clinic setting, throughout the organization, and across health care settings.
  • Provides relevant information across the care system, within Denver Health and with other healthcare systems and payers when member care is transferred between and among different specialties and / or within one or more organizations.
  • Provides information to the health care team including the member, family, and caregiver regarding available resources and benefits for health care services that ensures member choice and safe, timely transition.
  • Serves as point of contact within and among healthcare services and organizations.
  • Coordinates community resources.
  • Assures designation of primary responsibility among team members for each aspect of care plan, avoiding duplication and fragmentation.
  • Facilitates continuity of care using the multidisciplinary collaboration, and coordination of all appropriate healthcare services and community resources across the care continuum.
  • Orients member / caregiver to health care delivery system, services, access, and resources. (25%)

    • Health Teaching and Promotion :

  • Identifies barriers to goals and strategies to address.
  • Provides personalized education for optimal wellness.
  • Encourages preventative care such as immunizations and cancer screening.
  • Promotes appropriate utilization of resources.
  • Assists and educates caregiver when member is unable to participate.
  • Incorporates therapeutic communication, health literacy, cultural, and linguistic needs and preference into education and goals.
  • Supports members and caregivers in developing skills for self-efficacy to promote, maintain, or restore health such as healthy lifestyle tips, risk-reducing behaviors, age and developmental needs, daily living activities, and preventative care.

    • (25%)

    Care Coordination

  • Responsible for a defined caseload of Members enrolled in the DHMP Medicaid Choice who are identified as having a medium or low risk acuity level using data from a variety of sources, including the Member, their caregivers, providers, administrative claims data, pharmacy data and other inputs.
  • Obtains Member consent to participate in the program as well as to share clinical information with the Member's care team.
  • Works collaboratively with the Member to set SMART (specific, measurable, attainable, realistic and time-limited) goals and to graduate the Member to lower-intensity care programs and self-care within reasonable timeframes.
  • Works under the supervision and advice of the Supervisor who can provide insight into medical conditions, treatments, medications and answer medically-related questions as needed.

    • (25%)

    Education :

    Master's Degree Social Work required

    Work Experience :

    Three years of direct member care experience in acute, ambulatory care or community-based care required

    Licenses :

    Knowledge, Skills and Abilities :

    Bilingual in English / Spanish, preferred not required.

    Knowledge of emotional and social factors that impact patient's health.

    Shift

    Days (United States of America)

    Work Type

    Regular

    Salary

    $61,200.00 - $94,800.00 / yr

    Benefits

    Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

    Free RTD EcoPass (public transportation)

    On-site employee fitness center and wellness classes

    Childcare discount programs & exclusive perks on large brands, travel, and more

    Tuition reimbursement & assistance

    Education & development opportunities including career pathways and coaching

    Professional clinical advancement program & shared governance

    Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

    National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

    Our Values

    Respect

    Belonging

    Accountability

    Transparency

    All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

    Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

    As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

    Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

    Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

    Applicants will be considered until the position is filled.

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