Licensed Clinical Social Worker Behavioral Health Case Manager

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party benefit administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. 

What is your impact?

This position will assist members with behavioral health conditions navigate the behavioral health AND physical health continuum to reach their highest level of self-management, improve compliance with their dual diagnosis treatment plan and reduce their overall total medical expense. This position will support members with mental illness who are at risk or have high rates of utilization and/or psychosocial vulnerability. The LCSW provides support and/or intervention and assists members in understanding the implications and complexities of their current situation and/or overall personal care. Utilizing a member-centric approach, they assist members and their families in understanding and managing their behavioral health condition and its impact on their overall health: reinforcing the physician's treatment plan, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self-management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Caregiver, Families and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done telephonically or electronically through email and member and provider portals. The position also links members to community resources, services, and assists those who have exhausted their Medicare benefits.

What Will You Be Doing: 

• Engage Members telephonically with a focus on identifying behavioral health risk factors, educating member on worsening signs and symptoms, and providing member education with a focus on self-management and adherence to dual diagnosis treatment plans. 
• Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, other case management SMEs, the Community Health program and or community based resources. 
• Facilitate access to care by removing barriers to improve care delivery and promote participation in treatment plan. Identifies resources to meet the member behavioral health care needs. Provide education and tools to promote self-determination and independence. 
• Collaborate with Member, Member Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals. 
• Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses. 
• Assist with closing Risk Adjustment and care gaps 
• Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access. 
• Facilitate & document interdisciplinary care team meetings for at risk members as appropriate. 
• Coaches and educates members, and their representative using Behavioral Change Models. 

What You Must Have:

• 4+ years related work experience in Managed Care, Home Healthcare, and Community Healthcare 
• Master’s degree or additional related equivalent work experience in Social work, human services, psychology or related 
• LCSW – State Licensed Medical Social Worker 

Preferred Qualification: 

• Experience in both the Healthcare Industry and Managed Care. 
• Health Insurance Industry in a behavioral health field 
• Experience working with MS Word and Excel 
• RN may be substituted for LCSW
• Bilingual Spanish & English 
• Experience in Dual diagnosis of Mental Health and Substance Abuse 
• Telephonic Case Management Experience 
• Experience working with adult/geriatric population

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances.
• 401(k) includes employer contribution match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits options avaliable
• Comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. 

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.