About Job

Job Title: Social Worker Case Manager

Location: Pasadena, CA- The 2 days will be onsite training. Once training is complete, workers will be working fully remotely.

Duration: 12 + Months - (Possible extn/conversation)

Pay Rate: $30-35/hr.

Job Description:

Plans, develop, 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 members 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.