Position Summary: Provides social worker support to Colorado Community Health Alliance (CCHA) initiatives and the Primary Care Provider’s efforts in providing a medical home for Health First Colorado members. Focuses on patient self-management by providing coaching, health education, home visits, follow-up and support services as well as communicate patient information and care treatment plans back to primary care medical providers. Serves as a link between Health First Colorado members, community support services, health systems and providers in order to navigate through the medical home system of care to optimize member health outcomes. Partnering with Quality and other teams regarding department and network initiatives.

Employees will be required to show proof of being fully vaccinated to COVID-19 within 30 days of hire. Reasonable accommodations may be considered on a case-by-case basis for certain exemptions in accordance with applicable law. Applicants should be aware, though, that for external-facing roles, particularly those involving close contact with vulnerable individuals, accommodations that involve not being vaccinated against COVID-19 may not be deemed reasonable. The Company will engage in the interactive process on an individualized basis in light of each particular role.

This is a hybrid role on our Physical Health Adult Integrated team, mostly working from home 40 hours a week Monday - Friday

COMPETENCIES/Role-Specific Functions:

COMMUNICATION

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

• Functions as a liaison and advocate for Health First Colorado members between referring providers, specialty physicians, referral/care coordinators or other relevant staff and community resources to include care conferences and updates to their care team.

PROBLEM SOLVING

Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

• Completes comprehensive assessments to identify needs and barriers to the member’s ability to manage their medical conditions and treatment plans and participates with the member, caregivers, the primary care medical provider and health care team in developing a comprehensive care plan to overcome identified needs/barriers

PRODUCTIVITY

Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, handles information flow.

• Meets case workload and documentation requirements as defined by department standards.

SELF DEVELOPMENT

Seeks out and accepts feedback, is a proactive learner, takes on tough assignments to improve skills, keeps knowledge and skills up-to-date, turns mistakes into learning opportunities.

• Fulfills requirements necessary to maintain licensure.
• Conferences, publications, etc. to stay current on new treatments and trends.

CUSTOMER FOCUS

Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

• Develops strong telephonic and in-person relationships with Health First Colorado members that include assessing for care coordination needs, developing a joint care plan, providing appropriate member referrals to medical and non-medical resources and educating on the health care system.
• Develop and maintain a good working relationship with assigned primary care practices, healthcare team, community agencies, patients and families.

JOB KNOWLEDGE

Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

• Provides comprehensive social work care coordination to Health First Colorado members to include identifying and overcoming medical, psych-social, community, cultural/religious and financial barriers
• Works closely with health partner team to timely meet the care coordination needs of Health First Colorado members to include keeping up to date on current Health First Colorado, CCHA and community programs/resources.
• Maintain confidentiality and ensure compliance with HIPAA regulations.
• Communication expert on social services, when working with other departments.
• Communicates and provides expertise related to social determinants of health and is a resource in this area for other PHP departments.
• Other duties as assigned.

Qualifications (Education/Experience/Knowledge/Skills):

• MSW required
  • LSW or LCSW with valid license in good standing (preferred). (Required Licensure or Certification for this position must be maintained by the employee as defined by the company policies and procedures)
• Five years Social Work/Case Management experience with at least one year experience in community setting, i.e. home health care, discharge planning, department of social services etc.
• Teamwork skills.
• Strong work ethic to work independently.
• Self-motivated and self-managed
• Previous experience with Health First Colorado preferred
• Bilingual (English/Spanish) preferred.
• Knowledge and experience working with local Health First Colorado community resources for both medical and non-medical services
• Skilled in Motivational Interviewing preferred.
• Excellent verbal and written communication skills and the ability to convey information clearly to both internal staff and external members/partners.
• Intermediate level of competence on computer and internet skills required for routine data collection, data entry and reporting; intermediate experience with Microsoft Outlook, Microsoft Word and Microsoft Excel Spreadsheets
• Ability to work well in group and independent problem solving situations
• Excellent time management skills and ability to complete tasks on time; ability to multi-task.
• A valid unrestricted Colorado drivers’ license.
• Reliable and insured vehicle.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
• Mobile Device for work purposes as defined by the company policies and procedures.