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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

Position:  Licensed Medical Social Worker
Reports To: 
Division:  BANA Medical Affairs (2111)
Company:  ABCBS
Location:  Label
Job Code:  032169
Min Salary:   65900
Date Posted:  8/20/2013

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Position Specific Requirements: Arkansas LCSW license required.

Job Summary
The LMSW will work in the Medical Management area for BlueAdvantage National Accounts (BANA). The LMSW is responsible for providing support activities for members. This includes significant coordination with all departments within BANA facilities, and providers, to promote effective efficient care. This position will work closely with the BANA Medical Director, Director of Medical Management, 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
Previous experience in Care Management or Disease Management is preferred, or in integrated case management.

Minimum Job Requirements

1. Bachelors (or higher) degree in social work or health related field . Advanced degree preferred.

2. Experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment is required.

3. Arkansas LCSW 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, Marriage and Family Therapist, Professional Counselor.

4. Experience in direct clinical care with patients in facility-based and/or outpatient psychiatric or chemical dependency treatment is required.

5. Pror supervisory/management experience in a health-related field.

6. 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.

7. Experience in case management, home health, critical care, medical/surgical, social work, discharge planning or concurrent review.

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

9. Marketing experience preferred.

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. Develops goals and objectives with the collaboration of the member
3. Facilitates coordination, communication and collaboration on behalf of the member to achieve goals
4. Demonstrates clinical expertise in response to a variety of circumstances ranging from crisis intervention to routine business matters
5. Participates in clinical staffing
6. Presents clinical cases to staff and consulting providers upon request of superviso9r
7. Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards
8. Provides information to members and providers regarding community treatment resources, medical care programs, and policies and procedures and criteria
9. Coordination consultations with Walmart Physician consultants on clinical cases when necessary to facilitate care and progress
10. Complies with all Federal and applicable State laws and BANA, Arkansas Blue Cross Blue Shield 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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