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Central California Alliance for Health

Regional Medi-Cal managed care plan

Medical Social Worker

Case Management & AdvocacyConfirmed live in the last 24 hours
ContractCalifornia, USA$37 - $50

About the Job

Requirements

  • Knowledge of case management principles and practices, including assessment, care and treatment planning, discharge planning, and documentation.
  • Knowledge of community resources and means of accessing special services.
  • Knowledge of Medi-Cal and related policies and regulations.
  • Knowledge of reporting methods for cases of abuse or neglect.
  • Ability to use proactive customer service skills in handling complex and demanding situations.
  • Ability to advocate on behalf of individuals to ensure quality care and attainment of appropriate goals.
  • Ability to create, document, and implement intervention plans.
  • Ability to evaluate medical records and other health care data.
  • A Master’s Degree in Social Work.
  • Three years of social service experience in an acute care setting, community agency, or managed care environment, or an equivalent combination of education and experience providing the required knowledge, skills, and abilities.

Responsibilities

  • Develop and manage individualized intervention plans for members referred to the Case Management program, with the goal of promoting optimal, achievable outcomes in the most cost-effective and appropriate manner.
  • Work with the interdisciplinary Case Management team to facilitate quality outcomes across the continuum by educating members, providers, external agencies, and internal departments, and assisting members in navigating the managed care system.
  • Participate in Quality Improvement efforts to continually evaluate the Case Management Program’s effectiveness and its quality-driven, cost-effective goals and outcomes for Alliance members.

About the Company

Central California Alliance for Health

Regional Medi-Cal managed care plan

Central California Alliance for Health is a regional Medi-Cal managed care plan that provides health coverage for children, adults, seniors, and people with disabilities in Mariposa, Merced, Monterey, San Benito, and Santa Cruz counties, serving over 434,000 members. It works by enrolling members in a Medi-Cal plan and routing care through a network of primary care physicians and clinics to coordinate services and emphasize preventive care and ongoing management. It differs from many competitors through its mission-driven focus on improving access for low-income residents, its long history since 1996, and its community-oriented, network-based approach. Its goal is to pursue Healthy People. Healthy Communities by improving health outcomes and access to care for the communities it serves.

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