Social Work Care Manager

Social Work Care Manager - Hybrid Remote

Location:

US-MA-Worcester

Job

# Positions: 1

Category:
Social Work

About us:

Fallon Health is a company that cares. We prioritize our members‑always‑making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high‑quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self‑expression, and unique capabilities allow us to better serve our members.

We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio‑economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government‑sponsored health insurance programs— including Medicare, Medicaid, and PACE (Program of All‑Inclusive Care for the Elderly)— in the region.

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Brief summary of purpose:
The Social Work Care Manager (SWCM) works very closely with Fallon Health Care Team staff, Provider Partners, Community Partners, and/or community‑based groups to address service gaps and serves as a liaison to social and health resources on behalf of Fallon Health and the Fallon Health Care Management Models of Care. The SWCM collaborates and coordinates with State Agencies, DMH, DDS, DYS, DCF to ensure members care is efficient and coordinated.

The SWCM provides social service coordination services to members as referred, assessing member needs, services and resources to address social, health, or economic needs and facilitates referrals and collaboration with Provider Care Teams and BH Partners in the community. The SWCM assists the member and/or family to provide care utilizing FH benefits and/or community resources, developing a plan to coordinate a continuum of care consistent with the members' health care needs and/or goals.

The SWCM uses their knowledge of benefit plan design, eligibility and/or financing alternatives available within the community to provide options that meet member's needs. The SWCM identifies services, care delivery settings, and funding arrangements that meet the needs of the members. They recommend alternatives where appropriate. The SWCM monitors services and provides consistent feedback to the team on progress. The SWCM collaborates and works with members of the Care Team both at Fallon Health and at the Community Partners during time of member transition of care.

May attend in person care planning meetings, care coordination meetings, partner communication meetings, and other face‑to‑face meetings with providers, partners, and members to perform assessments, train staff, coordination communication and otherwise represent Fallon Health in a positive way. SWCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the BHCM and Care Team.

Responsibilities may include conducting in home/office face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The SWCM conducts assessments and refers members to community resources. The SWCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction.

Primary

Job Responsibilities:

• Member Care Coordination and
  
  Collaboration:
  • Provides culturally appropriate care coordination, i.e., works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers, and/or authorized representatives.
  • With member/authorized representative(s)…