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The Social Worker is responsible for the assessment, planning, coordination, and oversight of services for identified members within their respective healthcare plan. The position identifies, evaluates, and provides management of services for members with complex, catastrophic, SDoH (Social Determinants of Health) and/or psychosocial issues to promote quality, effective outcomes throughout the care continuum. The position ensures compliance with state and federal health plan requirements, Medicare guidelines and standards. Acts as a liaison to coordinate and collaborate care with physicians, family, and other providers while always remaining an advocate for members, putting them at the center of care delivery.  The Social Worker will interact and engage with others as an interdisciplinary team member. 

If you are located within South Carolina, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Perform comprehensive evaluations and document findings in a concise/comprehensive manner that is compliant with documentation standards for the Center for Medicare and Medicaid Services (CMS)
• Performs member assessments in multiple settings to include but not limited to the member’s home, the PCP/specialists clinic, hospital, and/or skilled nursing facility as needed
• Understands and plans to assure services provided work within the boundaries of the member’s plan eligibility. Coordinates identified member’s needs utilizing federal, state, and local community resources, as available 
• Coordinates with external and internal teams to minimize obstacles and increase in member and provider satisfaction
• Active participation in Performance Improvement (PI) or regional strategic initiatives
• Active participation in staff and Interdisciplinary Teams (IDT) meetings
• Adheres to organizational and departmental policies and procedures
• Maintains a high level of professionalism 
• Assumes responsibility for personal and professional development  
• Ensures licensure, certifications, and annual training are maintained and compliant
• Attends required meetings and participates in ad hoc committees as needed
• Maintains knowledge of all health plan benefits, network, NCQA regulations, health plan policies
• Identifies opportunities for process improvement in all aspects of member care
• Must maintain strict confidentiality at all times
• Must adhere to all department/organizational policies and procedures
• Performs all other related duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor of Social Work with 3+ years of experience 
• 3+ years of social work experience in a health care environment in adult case management
• Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
• Proven ability to read, analyze and interpret information in medical records, and health plan documents
• Proven ability to problem solve and identify community resources
• Proven planning, organizing, conflict resolution, negotiating and interpersonal skills
• Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously

Preferred Qualifications:

• Masters or Bachelor of Social Work with licensure (LMSW or LCSW or LBSW)
• 1+ years of managed care and/or case management experience
• Experience working with geriatric and behavioral and mental health member populations
• Long Term Care experience

Physical & Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving  

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.   

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.