Manager Social Work Case Management - Remote

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

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.

ESSENTIAL RESPONSIBILITIES

• •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 workgroups 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.

EDUCATION

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

EXPERIENCE

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
• •Health plan/payer experience
• •Telephonic care delivery experience

KNOWLEDGE, SKILLS & ABILITIES

• •Written and verbal presentation skills, and skills in positively influencing others with respect and compassion.
• •Utilizes clinical platforms, workflow technologies, reporting tools, and digital engagement solutions to optimize team performance and member outcomes.
• •Use of emerging technologies, including adoption of AI-enabled tools, to improve operational effectiveness and decision-making.
• •Identifies opportunities for automation and process improvement.
• •Understanding of healthcare cost drivers and the broader healthcare service system.
• •Proficient computer skills, including Microsoft Office products.
• •Leads a remote and/or geographically dispersed workforce through effective virtual leadership practices.
• •Maintains employee engagement, accountability, communication, and productivity within a virtual environment.
• •Excellent interpersonal/consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
• •Ability to work in a high performing team environment that requires flexibility
• •Excellent organizational, time management and project management skills
• •Demonstrated ability to handle multiple priorities in a fast paced environment
• •Influences and collaborates with clinical, operational, provider, quality, product, analytics, and client-facing stakeholders to achieve enterprise objectives.
• •Experience leading organizational change initiatives
• •Represents social work in enterprise initiatives and strategic workgroups.

LICENSURE

REQUIRED

Licensed Social Worker (LSW), Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

Preferred:

• •LSW or LCSW
• •Certified Case Manager (CCM)
• •Lean/Six Sigma training/certification

TRAVEL REQUIREMENT:

0% - 25%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Position Type: Office-Based

Physical Work Site Required: Yes

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as