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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

Position:  Licensed Master Social Work Case Mgr
Reports To: 
Division:  BANA Medical Affairs (2111)
Company:  ABCBS
Location:  Label
Job Code:  032169
Min Salary:   67200
Date Posted:  8/20/2013

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Position Specific Requirements: Arkansas LCSW license required.

Job Summary
The Licensed Master Social Work Case Manager will work in the Medical Management area for BlueAdvantage National Accounts (BANA). The Licensed Master Social Work Case Manager is responsible for providing support activities for members. This includes significant coordination with all departments within BANA facilities, and with providers, to promote effective, efficient care. This position will work closely with the BANA Corporate Medical Director, Director of Medical Management, BANA Pharmacist and Manager of Medical Affairs.

Nature & Scope
Qualifications, Skills, Knowledge and Abilities
1. Ability to comprehend medical policy and criteria to clearly articulate health information is required.
2. Excellent communication and interpersonal skills are essential.
3. Self-motivation and the ability to assume a lead role in ensuring that all objectives are met is desired.
4. Previous experience in Care Management, Disease Management or in integrated case management is preferred.

Minimum Job Requirements

1. Master's degree in Social Work.

2. Experience in direct clinical care with patients in hospital, facility or community-based environment is required.

3. Arkansas (or Texas, depending on location) LMSW license and in good standing with clinical practice experience. Qualified candidates will have a current, unrestricted license to practice as a Master's Level Social Worker. Arkansas LCSW (or other state equivalent) preferred.

4. Supervisory/management experience in a health-related field preferred.

5. CCM Certification required. If certification not obtained prior to employment, must be eligible to sit for exam by the second year of employment, and retest until passed (at least on a 6 months basis).

6. Experience in case management, home health, critical care, social work, discharge planning or utilization review.

7. Proficient computer skills (Word and Excel) required.


Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

1. Conducts telephonic assessments with the members to gather information regarding the member’s current treatment, possible treatment needs and identify any barriers to accessing services.
2. Collaborate with nurse case manager and assist member in the development of both short term and long term goals.
3. Research and provide information to members and providers regarding available resources with employer or within the community to overcome barriers to achievement of goals such as “lending closets” for DME, housing and financial assistance, special care programs, and transportation.
4. Facilitates coordination, communication and collaboration on behalf of the member to achieve goals.    
5. Demonstrates clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters.
6. Participates in staff activities such as Grand Rounds and collaborates with Medical Director, other social workers, care managers, and supervisors to help the member.
7. Presents clinical cases to staff and consulting providers upon request of Supervisor.
8. Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
9. Coordinates consultations with Medical Directors on clinical cases when necessary to facilitate care and progress.
10. Complies with all Federal and applicable State laws, as well as BANA and Arkansas Blue Cross and Blue Shield (ABCBS) policies regarding privacy, confidentiality and security of health information, and other designated information.
11. Provides follow-up and support calls to members and providers as needed and as assigned by Manager/Supervisor.
12. Participates in on-going continuing education as required by professional licensure, certification, or as requested by ABCBS, URAC compliance policies, and social work licensing requirements.
13. Participates in special committees or projects for program development as assigned by Manager/Supervisor
14. Assumes other duties consistent with position and as directed by Manager/Supervisor.
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