Full-Time
Social Worker
SNP, Peak Health
Updated on 8/12/2026
Peak Health
51-200 employees
Provider-led health insurer with Medicare Advantage
No salary listed
Remote in USA
Remote
Some travel may be required to offsite meetings.
Master's
 Medical, Clinical & Veterinary (1) |
|---|
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- A master’s degree in social work or a related field is required.
- Current social worker licensure applicable to the service area is required: West Virginia LGSW, LCSW, or LICSW; Pennsylvania LSW or LCSW; Ohio LSW, LISW, or LISW-S; or Maryland LMSW, LCSW, or LISW-C.
- Two years of clinical experience are required.
- The role requires knowledge of CMS regulatory and contractual documents, Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.
- Proficiency with Microsoft Office products is required.
- The role requires the ability to work under stressful working conditions and meet defined deadlines and deliverables.
- The role requires the ability to stand and walk short distances for eight or more hours, bend, stoop, or stretch frequently, lift 30 pounds, and push 50 pounds.
- Some travel may be required to offsite meetings.
- Participate in care management program build, implementation, oversight, and delegation activities.
- Assist with compliance with CMS SNP Model of Care expectations, NCQA standards, and Medicare Advantage regulatory requirements.
- Perform psychological, social, and economic care management interventions for members with severe or persistent mental or emotional disorders.
- Perform telephonic behavioral health comprehensive assessments covering members’ environmental, behavioral, psychological, economic, and social factors.
- Assist in developing individualized and culturally sensitive care plans with the assigned care manager, including problems, interventions, barriers, and goals.
- Perform telephonic reassessments, revise care plans, and evaluate care plan effectiveness.
- Participate as a member of the interdisciplinary care team for members with social determinants of health and behavioral health needs and attend meetings when appropriate.
- Recognize early signs of member decompensation requiring immediate case management intervention and promote compliance with treatment plans.
- Serve as an additional point of contact during transitions of care.
- Co-manage member cases with the care manager to address psychosocial, economic, and cultural issues affecting care needs.
- Serve as a primary socioeconomic resource for the D-SNP care management team.
- Document member cases accurately and promptly to support coordination of care needs.
- Adhere to CMS, Code of Federal Regulations, and local, state, and national regulatory requirements and guidelines, including those in the Model of Care.
- Collaborate with the interdisciplinary care team to facilitate community resource assistance for members with identified needs.
- Screen, identify, diagnose, treat, and manage mental health and substance abuse problems in patients and family members.
- Use hospital, medical center, and health system resources to access and provide patient care.
- Maintain knowledge of community agencies and resources and serve as a liaison between those agencies and the healthcare system.
- Coordinate appropriate resource and financial management, including financial assistance referrals, entitlement program referrals, and patient benefit coordination.
- LICSW certification in West Virginia is preferred.
- Experience managing Medicare and/or Medicaid populations is preferred.
- Two years of behavioral health experience is preferred.
Peak Health operates as a provider-led health insurer in West Virginia, offering health plans including Medicare Advantage PPOs and options for employer groups. Its products, such as Peak Advantage, are designed with local doctors and health systems to simplify access to care, streamline billing, and improve communication between members and healthcare providers. It differentiates itself by being locally based and provider-owned, connecting hospitals and clinics with the insurer to align incentives and improve member service. Its goal is to expand affordable, accessible care for communities by starting with employer coverage and Medicare Advantage expansion across West Virginia and parts of Pennsylvania.
Company Size
51-200
Company Stage
N/A
Total Funding
N/A
Headquarters
Morgantown, West Virginia
Founded
N/A
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Simplify's Take
What believers are saying
- Peak Advantage expands into 20 West Virginia counties and Fayette, Greene in 2026.
- Enrollment tripled in January 2026, topping 10,000 members, signaling strong demand.
- CMS 4.5-star rating in July 2026 boosts sales and broker confidence.
What critics are saying
- 2026 MA footprint still centers on West Virginia, tying growth to a narrow geography.
- Peak Health depends heavily on WVU Health System employees and Medicare membership.
- Medicare ratings and complaints drive retention; weak service hits renewals by 2026.
What makes Peak Health unique
- Provider-owned by WVU Medicine, Marshall Health Network, and Valley Health, aligning incentives.
- West Virginia-based Medicare Advantage gives Peak Health local credibility against national carriers.
- Claims, care navigation, and employer administration sit under one regional operating model.
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Benefits
Hybrid Work Options