Job Description
Job Summary
The Community Social Worker (CSW) will work in coordination with the Care Team and other stakeholders by utilizing targeted member outreach to identify and address member's social determinates of health and need for community resources. The CSW will engage/consult members and complete appropriated social work assessment(s) to determine the nature of a member's situation by conducting telephonic/virtual interviews to assess and determine member's medical, psychological, emotional, financial, and social status. The CSW will be responsible for identifying barriers to the members care plan. This role will also be required to assist members with exploring community resources and referring members to appropriate community resources. Assists members manage their daily lives, understand and make difficult health care choices and obtain social services, such as health care and government assistance.
Essential Functions
- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Operates as a member advocate utilizing skills that respect issues of cultural considerations for every patient and family.
- The CSW and activities is a key contributor to the member Engagement annual target and ROI value.
- The CSW will maintain and manage their own member caseload for members received from a daily worklist and serve as a consultant for referrals sent from numerous sources on cases managed by other Care Team members.
- Determine member's discharge status and identify and coordinate any additional needs and services that require ongoing Care Coordination services and resources (i.e., targeted emergency department frequent utilizers).
- The CSW will use a standardized, evidence based social need/SDoH assessment tool to evaluate and identify member needs (psychosocial status, financial, and physical needs of members; assess patient's support systems, available community resources and other factors to plan, develop, and implement an appropriate plan of care.
- Identifies and screens high risk members that would benefit from coordination of community health related services, behavioral change counseling and
- refer members to appropriate care programs and other members of the care team (RN Care Managers, Registered Dieticians, LCSW (behavioral health) and Pharmacists).
- Assess member's end of life planning and provide appropriate resources and referrals.
- Coordinate care for members as appropriate based on care/treatment plan and benefit limitations.
- Educate members and assist with formulating strategies/goals to help prevent disease, disability and or pre-mature death.
- This position will also be responsible to vet the tools and resources most commonly used by the discipline to ensure accuracy, relevance and appropriateness also maintains the internal community resource site.
- Serve as members' point of contact as needed to provide education regarding benefits, network, network access and community and government agencies that are available to assist members when benefits are not available or exhausted.
- Evaluate, reports, and participates in effectiveness of discharge planning activities, patient care conferences and referrals to appropriate behavioral and community resources.
- Collaborates with internal and external partners to remove barriers access and or Care Management staff to address the care and social service needs of members through member engagement.
- Provide consultation to RN care managers, dieticians, pharmacists and LCSWs (behavioral health).
- Collaborate and provide consultation support to external stakeholders (hospital d/c planners, SNF/rehab facility staff, care partners and vendors).
- Identify and implement continuous improvement opportunities.
- Miscellaneous project assigned by Manager (adhoc reports, projects, etc.).
Required Work Experience
3+ years related work experience in Healthcare Industry and Managed Care, assisting with discharge planning, linking to community resources, navigation of financial assistance programs, chronic illness resources, etc.
Related bachelor's degree required Minimum bachelor's degree in social work, sociology or psychology or addition related equivalent work experience.
Extensive knowledge of community resources (local, statewide, national, and international)
Experience with the Healthcare industry and Managed Care
Demonstrated knowledge in Social Work care management
Non-traditional working hours to meet the member's availability and business objectives
Intermediate to Advanced PC skills, experience and/or knowledge of digital engagement tools a plus
Preferred Education
Master's degree Social Work or related
Bi-lingual (Spanish, or Creole, or French)
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer:
As a Florida Blue employee, you will be at the heart of GuideWell's vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan including employer match;
- Paid time off, volunteer time off, 10 holidays and 2 well-being days;
- Additional voluntary benefits available; and
- A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $65,400 - $106,200
Typical Annualized Hiring Range: $65,400 - $81,700
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.