Social Worker - LSW - Clinical Management

Summa Health

place Akron, 44302

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Telehealth

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Social Work, Other Behavioral, Mental, or Healthcare Field

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Internship

local_atm $28.10 - $42.15 an hour

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PTO, Flexible Spending Account, Other Benefits

SummaCare - 1200 E Market St, Akron, OH

Part-Time / 20 Hours / Days

LOCAL - Remote after training

Summary :
Collaborates across a broad continuum of care to assess, plan, implement, coordinate, monitor and evaluate services to support and to meet individual member’s health care needs as part of the care management team; coordinates with care managers, physicians and other providers to provide optimal care for the member in the appropriate setting; provides support for transitions across the continuum of care for plan members. Supports member experience, quality outcomes, organizational goals, cost efficiency, and compliance with regulatory requirements through the appropriate referrals to clinical programs, care management tools, and community resources.

Assists patients and family members foster coping strategies; assess psychological patient needs, contribute in the development of care plans. Identifies the appropriate level of support from self-management education to end-of-life services.

Assists the clinical team in completing a comprehensive psychosocial assessment and subsequently establishing a patient’s plan of care in alignment with the care team. Establishes and advocates for support services to patients and families, as well as care plans that are sensitive to the patient’s unique psychosocial needs, health status, and overall goals and values. Supports clinicians to operate as efficiently as possible.

1. Formal Education required:
a. Current LSW in state of Ohio
b. Bachelor’s Degree in Social Work, Master’s Degree preferred
c. CCM certification or equivalent preferred
d. NCQA experience preferred

2. Experience & Training Required:
a. Three (3) years recent/current experience performing same or similar responsibilities. Relevant recent experience includes previous industry, care manager/care coordination experience in a hospital, home health, behavioral health, or community care management agency.
b. Telephonic Care Management experience preferred.
c. Prior health plan/managed care experience helpful.
d. Prior experience working with aged, chronically ill/disabled, behavioral health, maternity, or any combination helpful.

Essential Functions:

1) Collaborates, develops, integrates, and maintains professional working relationships and member support systems with applicable care managers, PCPs, physician’s office staff, other clinicians, community resources, caregivers, employers, and other health care providers to effectively achieve and manage recommended delivery of services for chronic and catastrophic/complex care coordination.

2) Determines nature of member’s situation by interviewing member, assessing medical, psychological, emotional, and social information.

3) Gathers pertinent information from a variety of sources including physician and hospital records, utilization data, plan records/data and information from other health care providers to assist in development of an individualized plan of care. Evaluates effectiveness of the plan of care, modifies and adjusts as appropriate to achieving desired process, utilization and clinical outcomes.

4) Obtains assistance for member by referring him/her to community resources, arranging for appointments and establishing rapport with other agencies.

5) Determines and provides/arranges for the appropriate level of support to meet the member needs, ranging from self-management education to complex care management to End of Life services; varying outreach frequency as member needs change.

6) Takes ownership in identifying and obtaining education and training needed to meet needs of the members.

7) Occasional overtime work throughout the year. Occasional travel which may require use of personal auto to visit a member or provider office, attend meetings, conferences, workshops, and/or seminars.

8) Evaluates member care scenarios against the member benefits to identify and implement alternative care options to improve quality of life, reduce the cost of care and insure efficient utilization of resources.

9) Completes care management documentation according to NCQA, CMS and other regulatory standards and department procedures. Maintains up-to-date case management case status and labeling in the case management information system. Meets department standards and metrics for processing and managing cases.

10) Participates in organizational and health system quality improvement and program activities as assigned by supervisor.

11) Maintains working knowledge of NCQA and regulatory (CMS, State Department of Insurance) standards relative to care management; consistently delivers care management services in compliance with these standards.

12) Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional, and respectful manner.

3. Other Skills, Competencies and Qualifications:
a. Demonstrate knowledge and skill identifying and coordinating the needs of chronically ill patients and families or members with complex psychological and social needs as well as.
b. Knowledge of medical terminology
c. Strong clinical and assessment skills for a variety of patient populations.
d. Exhibits strong customer service focus and interpersonal skills
e. Excellent written and verbal skills
f. Demonstrates leadership skills
g. Basic computer skills needed to collect, assess, and enter data.
h. Working knowledge of Microsoft Outlook and Word; knowledge of Excel and Powerpoint helpful.
i. Excellent attention to detail.
j. Multitalented
k. Problem solver with eagerness to tackle complex problems and tasks
l. Demonstrate knowledge and skills necessary to provide care appropriate to the age of the members serviced.
m. Work cooperatively with team members to accomplish organization’s mission and goals.
n. Demonstrate knowledge and skills necessary to provide care appropriate to the age of the members serviced.
o. Maintain confidentiality of member health and business information.
p. Organize and manage time to accurately complete tasks within designated periods in fast-paced environment.
q. Flexible: ability to adjust work hours to meet business demands.
r. Ability to travel from location to location throughout the workday.
s. Ability to effectively interact with populations of members/customers with an understanding of their needs for self-respect and dignity

4. Level of Physical Demands:
a. Sit and/or stand for prolonged periods.
b. Bend, stoop, and stretch.
c. Lift up to 20 pounds.
d. Manual dexterity to operate computer, phone, and standard office machines.

Equal Opportunity Employer/Veterans/Disabled

As a regional, provider-owned health plan, SummaCare values the relationship between the members and their doctors. SummaCare is a part of Summa Health, an integrated healthcare delivery system that includes Summa Health System hospitals, its community-based health centers, dedicated clinicians and SummaCare. Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

$28.10/hr - $42.15/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.