About Job
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Program Overview: This role will be 50-75% travel within a 50 mile radius- Miami Dade County. Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary: The Social Worker participates in the care planning process in collaboration with the Care Manager, to include the following actions: assessment, goal setting, establishing interventions related to goals, identifying barriers and strategies to address, monitoring success of the interventions, evaluating the success of the overall care plan and reporting outcomes. Fundamental Components: Care Management activities are conducted through a combination of telephonic and face to face interactions which include visits to member homes, in the community, facilities and/or provider locations. Care management activities will focus on quality of care, compliance, outcomes and decreasing costs. Responsible for developing and carrying out strategies to coordinate and integrate post-acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care. Performs initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or care programs. Applies social work concepts, principles, and strategies in addressing the social determinants of health needs in members individualized care plan. Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of members and progress towards goals. Serves as a member advocate to ensure the member receives all the necessary care allowed under the member’s benefit plan and as available through Medicaid benefits and/or other community resources. Develops relationships with hospital social workers and community resources and utilizes available data to assure appropriate care management of catastrophic, acute, and chronically ill members with the goal of appropriate utilization, decreased length of stay, and preventable emergency room utilization. Assists in the identification and reporting of potential quality improvement issues. Directs social work interventions including performing psychosocial assessment of the populations, telephone follow up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate information and referral. Required Qualifications: Candidate must reside in or near Miami Dade County (FL). Candidate must possess an active and unrestricted Licensed Master Social Worker (LMSW) licensure or higher in the state of Florida. 2+ years experience in medical social work or case management. Candidate must be willing and able to travel up to 75% of the time in the Miami Dade County area. Reliable transportation required (Mileage is reimbursed per our company expense reimbursement policy). Preferred Qualifications: Bilingual (English / Spanish). Education: Master's Degree in Social Work. Certification: Active and unrestricted Licensed Master Social Worker (LMSW) licensure or higher in the state of Florida.
Professional Field


Patient Focus
Diagnoses
Avoidant Personality Disorder
Therapeutic Approach
Methodologies
ECT
Modalities
Individuals
Practice Specifics
Populations
Victims of Crime/Abuse (VOC/VOA)
Aviation/Transportation
Racial Justice Allied
Settings
In-patient Non-Psychiatric
In-patient Psychiatric
Research Facilities/Labs/Clinical Trials
Schools
Home Health/In-home
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