Social Worker Disease Management
Social Worker Disease Management
Posted on :
13-10-2024
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Job Description
Title: Social Worker Disease Management
Duration: 3 months Contract to Hire
Shift: Standard Mon to Fri
Location: Remote
Job Summary
- Provides Disease Management (DM) services to TRICARE beneficiaries.
- The Social Worker Disease Management collaborates with the clinical team to consult and collaboratively support the assessment planning implementation coordination monitoring and evaluation the beneficiarys health and psychosocial needs with a focus on empowering the beneficiary to successfully manage their medical behavioral and psychosocial needs related to their chronic condition.
- The SW will partner with the interdisciplinary care team to identify appropriate care to prevent complications related to chronic conditions and minimize the risk of potential exacerbation using evidencebased conditionspecific tools and support.
- This role requires the individual to contribute to care planning activities in collaboration with internal clinicians providers patients families as appropriate and assesses the effectiveness and outcomes to improve individual health status
Responsibilities
- Assess beneficiaries to identify medical physical and psychosocial needs to support the beneficiarys overall goals of care.
- Collaborate with the clinical to contribute to the wholeperson plan of care by incorporating behavioral and psychosocial assessment findings utilizing evidencebased guidelines clinical reasoning and clinical practice guidelines.
- Provide education and coaching support specific to the beneficiarys behavioral and psychosocial needs to prevent to support management of their chronic condition.
- Manage activities necessary to ensure appropriate utilization and access to medical and behavioral resources while maintaining optimal standards of care.
- Review identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
- Participates in the development of measurable outcomes ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
- Assesses high risk factors acuity and need for other TRICARE services and resources.
- Facilitate transfer of beneficiaries between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.
- Adhere to URAC standards TRICARE policy contractual requirements and nationally recognized practice standards.
Education & Experience
Required
- Current unrestricted SW licensure to independently work within scope of practice within state of residence (BSW)
- U.S. Citizenship
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
- Minimum of two of years experience in case management care coordination or discharge planning in an acute ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO)
Preferred
- Care or Disease Management experience with a managed care organization (MCO)
- Masters degree in Social Work MSW; LCSW LMSW
- Knowledge of government healthcare programs TRICARE and Medicare/Medicaid
Working Conditions
- Ability to cover any work shift
- Ability to work overtime if needed
- Onsite: Works within a standard office environment
- Remote: Private and secure workspace and workstation with highspeed internet is required
- Extensive computer work with prolonged sitting wearing of headset typing speaking on a phone
Employment Type
Full Time
Key Skills
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