Manager Social Work Case Management - Remote

Company :
Highmark Inc. Job Description :

This job leads a team of licensed clinical professionals who deliver social work case management services to a specified panel of the Organization's members that range in health status/severity and clinical needs. Serves as a clinical operations leader accountable for clinical quality, member outcomes, regulatory compliance, workforce development, and business performance. Cross-functional execution/operationalization of strategic enterprise initiatives. Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined time frames and according to established processes.

This job ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes. Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved.

Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority. Assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets, in collaboration with leadership Provide clinical leadership and oversight to ensure adherence to evidence-based social work practices, psychosocial assessment and intervention approaches, member advocacy principles, and organizational clinical policies.

Ensure consistency and quality of member assessments, care plans, interventions, and documentation. Serve as a clinical resource and escalation point for psychosocially complex cases. Ensure team members maintain clinical competency in motivational interviewing and other engagement techniques necessary to achieve market engagement and clinical targets for the assigned population. Support ongoing staff development by assessing individual strengths, skill sets, and development needs, and providing coaching, education, and professional development opportunities to enhance team capability and performance.

Review department performance in relation to established metrics and implement changes in collaboration with other multidisciplinary team managers to effect continual improvement in the services provided. Lead/participate in both departmental and interdepartmental work groups to continually enhance the delivery of social work programs and services and proactively respond to changing client and market expectations. Identify cost savings opportunities within the department and/or operations, in collaboration with leadership.

Participate in both internal and external assessments of performance by preparing for, participating in and responding to audit findings and recommendations. Monitor and drive improvement in key metrics such as engagement rates, care plan completion, program outcomes, quality measures, member satisfaction, and cost of care. Ensure that all services are delivered consistent with applicable internal policies and procedures as well as applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for social work.

Work with other departments, including Health Plan Operations, Provider Relations, Client Management, etc. to identify engagement opportunities, providing a seamless member experience. Other duties as assigned or requested.

Minimum:
Master's Degree - Social Work or Social Welfare, Counseling, Psychology, Public Health, Public Healthcare administration or other clinically relevant field. Preferred: MS in Social Work or Social Welfare Substitutions:
None

Minimum: 5 years of health-related clinical work experience 3 years' management, supervisory, team lead and/or project leadership experience Preferred:
Management, supervisory, team lead and/or project leadership experience within social work, care management, population health, or healthcare operations Supporting the healthcare needs and population health of diverse populations Understanding of the importance of cultural competency in addressing targeted populations…