SNP Social Worker – Peak

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🏈 Ohio, Maryland, +3 more states – Remote

🏈 Ohio – Remote 🦀 Maryland – Remote 🔔 Pennsylvania – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Participate in activities related to care management program build, implementation, oversight, and delegation. • Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements. • Perform psychological, social and economic care management interventions for members with severe/persistent mental or emotional disorders. • Perform telephonic behavioral health comprehensive assessments of members’ environmental, behavioral, psychological, economic and social factors. • Assist in the development of individualized and culturally sensitive care plans in collaboration with the member’s assigned CM, identifying problems, interventions, barriers and goals. • Performing telephonic re-assessments, care plan revisions and evaluating the effectiveness of the members’ care plan. • Member of the ICT for members with SDOH and BH needs and participates in ICT meetings when appropriate. • Recognizes early signs of a members’ decompensation that requires immediate case management intervention that promotes and motivates compliance with treatment plan. • Serves as an additional point of contact during transitions of care. • Co-manages member cases with the CM to address psycho-social, economic and cultural issues that may impact the members’ care needs. • Serves as a primary socio-economic resource for the D-SNP Care Management Team. • Documents in the members’ case accurately and timely to ensure coordination of the members’ care needs. • Adheres to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC. • Collaborate with all members of the interdisciplinary care team to facilitate appropriate community resource assistance for members with identified needs. • Screens, identifies, diagnoses, treats and manages mental health and/or substance abuse problems in patients and family members. • Knowledge of hospital, medical center and/or health system resources to access and provide for patient care needs. • Maintains a working knowledge of community agencies and resources and serves as a liaison between them and the healthcare system. • Collaborates for appropriate resource and financial management which may include but is not limited to-financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.

🎯 Requirements

• Masters Degree in Social Work or related field • Current social worker licensure for the applicable service area: WV: Licensed Graduate Social Worker (LGSW), Licensed Certified Social Worker (LCSW) or Licensed Independent Social Worker (LICSW) through the West Virginia Board of Social Work. PA: Licensed Social Worker (LSW) or Licensed Clinical Social Worker (LCSW) through the Pennsylvania Board of Social Workers, Marriage and Family Therapists and Professional Counselors. OH: Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), or Licensed Independent Social Worker-Supervision (LISW-S) through the Ohio Board of Social Work. MD: Licensed Masters Social Worker (LMSW), Licensed Certified Social Worker (LCSW), or Licensed Certified Social Worker-Clinical (LISW-C) through the Maryland Board of Social Work. • Two (2) years of clinical experience. • LICSW certification in the state of West Virginia (preferred). • Management of Medicare and/or Medicaid populations (preferred). • Two (2) years of Behavioral Health experience (preferred).

🏖️ Benefits

• Standard office environment • Some travel may be required to offsite meetings