Social Worker/Healthcare Consultant

A-Line Staffing is now hiring a Social Worker in Kansas City, KS. The Social Workerwould be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.

If you are interested in this position, please contact Brad Zidek at 412-823-2500or bzidek@alinestaffing.com

_____ Responsibilities

• Minimum Qualifications Bachelor of Social Work from an Accredited Social Work Program or equivalent education and experience. Basic computer skills to include but not limited to Microsoft Office Products. Role Description: Provide support services in areas such as conducting on-site monitoring reviews of long term living service providers to ensure that consumers are receiving appropriate care that meets State and Federal guidelines. Review written documentation and meet with consumers and stakeholders to evaluate the quality of the services being provided. They will monitor issues related to medical and financial eligibility of the consumer. Statewide travel required as necessary including some overnight

This will be a full-time telework role in Kansas, however, will require 50-75% travel for face-to-face visits in assigned area once COVID restrictions are lifted. Schedule is Monday-Friday, standard business hours. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and
education for members through the use of care management tools and resources.
Evaluation of Members:
- Through the use of care management tools and information/data review, conducts comprehensive
evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or
meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning
components with appropriate referral to clinical case management or crisis intervention as appropriate
- Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health
programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to
obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and
promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent
medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and
accreditation guidelines and company policies and procedures

If you think this position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting! Please contact Brad Zidek at A-Line staffing 412-823-2500!
bzidek@alinestaffing.com