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Utilization Management Medical Social Worker

Company: Central California Alliance for Health
Location: Scotts Valley
Posted on: September 15, 2018

Job Description:

ABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 350,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video.

WHAT YOU'LL BE RESPONSIBLE FORParticipating in the UM Concurrent Review and Care Transitions interdisciplinary teams responsible for the psychosocial management of members in long term care placements and members newly discharged from an acute care or skilled care setting that are at high risk for re-admission. You will work with, provide assistance and educate members, providers, external agencies and internal departments on UM Concurrent Review programs. You will participate in Quality Improvement studies to continually evaluate program effectiveness and promotion of quality driven, cost effective and achievable goals and outcomes for members.


  • Knowledge of:

    • The principles and practices of case management, including assessment, care/treatment planning, discharge planning and documentation
    • The principles and practices of care transitions and coordination
    • Governmental and non-profit resources utilized to assist member in achieving goals

    • Ability to:

      • Effectively interview members to determine their strengths, problems, prognosis, functional status, goals, and needs for specific services and resources, and to establish short- and long-term goals
      • Create, document, and implement intervention plans
      • Advocate on behalf of the individual to assure quality of care and attainment of appropriate goals
      • Manage person who are non-compliant and/or have a history of behavioral health issues
      • Evaluate medical records and other health care data
      • Use pro-active customer service skills in handling complex and demanding situations
      • Exercise good judgement and tact in relating to members and health care providers

      • Education and Experience:

        • Master's Degree in Social Work

        • 2 years of Social Work experience in an acute care setting, community agency or managed care environment or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying

          OUR BENEFITS

          • Medical, Dental and Vision Plans
          • Ample Paid Time Off
          • 11 Paid Holidays per year
          • 401(a) Retirement Plan
          • 457 Deferred Compensation Plan
          • Robust Health and Wellness Program
          • Fresh Fruit Delivery
          • EV Charging Stations
          • And many more

            To read the full position description, and list of requirements click here.Applicants must be currently authorized to work in the United States on a full-time basis.

            Keywords: Central California Alliance for Health, San Francisco , Utilization Management Medical Social Worker, Healthcare , Scotts Valley, California

            Click here to apply!

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