Location: Pasadena, CARequired Skills & Qualifications

Applicants must be able to work directly on W2.
Master's Degree in Social Work is mandatory.
Minimum of 2 years of experience as a Social Worker.
Prior experience in the healthcare industry is essential.

Day-to-Day Responsibilities

Plan, develop, assess, and evaluate care provided to members.
Conduct baseline medical and psychosocial evaluations and create individualized patient care/treatment plans with primary care and specialist physicians.
Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
Develop and maintain case management policies and procedures.
Coordinate care/services with utilization and/or quality reviewers and monitor the level and quality of care.
Coordinate the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining necessary authorizations/approvals/transfers for outside services for patients/families.
Consult with internal and external physicians, healthcare providers, discharge planning, and outside agencies regarding continued care/treatment or hospitalization or referral to support services or placement.
Arrange and monitor follow-up appointments.
Encourage members to follow the prescribed course of care (e.g., drug therapy, physical therapy).
Make referrals to appropriate community services and outside providers.
Identify and recommend opportunities for cost savings and improving the quality of care across the continuum.
Develop and collect data; trend utilization of healthcare resources.
Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
Coordinate transmission of clinical and benefit treatment to patients, families, and outside agencies.
Act as liaison for outside agencies, non-plan facilities, and outside providers.
Coordinate repatriation of patients and monitor their quality of care.