Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Use your strengths as a Case Management Social Worker at Wellmark! 

About the role: In this role, you will provide social work support service to members and health care providers. This requires the utilization of health care systems and community resource knowledge/expertise to provide consultation and responses to community support requests. You will proactively assess and assist members with future care needs to help move them through the continuum of care and utilize support services and resources efficiently. You’ll also function as part of a multi-disciplinary care team to continuously look for ways to improve processes and maximize health dollars for our members. You have a passion for behavioral health and have direct experience in this area that will help Wellmark grow and expand behavioral health services for our members. 

About you: Our strongest candidates are mission driven – they believe health care and the member experience can be better, and they are passionate about finding new ways to influence this work. They’re resourceful, knowledgeable advocates who enjoy connecting others with resources. Thinking critically, piloting work, proactively planning, and supporting others in a dynamic environment is where they shine. Most importantly, they acknowledge that this is not work that can be done alone. They are collaborative in approach, develop deep partnerships, and value the expertise of others.  Technology savviness, such as experience in utilizing and troubleshooting Microsoft Office products (Outlook, Excel, Teams, etc), is a must. 

In this position, you will be required to obtain Certified Case Manager (CCM) certification within 24 months from date of hire and maintain throughout time served in position. 

Must be flexible and have the ability work weekend and/or holiday hours when needed on a rotational basis. Core hours will fall between 8am-5:30pm Central Time, with a rotation every six (6) weeks to an earlier (7:30am) or later (9:30am) start time.  

Remote eligible position - Candidates in Iowa or South Dakota preferred. 

Required:

• Bachelor's degree in Social Work (BSW).
• Active and unrestricted Social Work license in Iowa or South Dakota; individual must be licensed in the state in which they reside. Certified Case Manager (CCM) certification within 24 months from date of hire and maintain throughout time served in position.
• 2+ years of clinical social work experience in an acute care or outpatient setting with a minimum of 2 years of full-time equivalent experience of direct clinical care to the consumer.
• Knowledge of community health and social service agencies and additional community resources. Ability to foster and maintain professional working relationships with community agencies.
• Commitment to service excellence and member advocacy. Anticipates member and provider needs and takes appropriate actions; thinks critically and creatively yet understands resources and guidelines.
• Operates with agility, flexibility, and resourcefulness; effectively manages and adapts to change.
• Ability to organize multiple priorities and succeed in a dynamic work environment where quality goals are measured. Committed to timeliness, follow up, accuracy and detail.
• Strong verbal communication skills. Influences action and facilitates crucial conversations on care with members, physicians, and care facilities. Excellent crisis-counseling and problem-solving skills.
• Strong written communication skills, including accurate documentation of events within electronic documentation system; ensures quality and consistency by following set guidelines and processes.
• Develops collaborative relationships and maintains professionalism with peers, stakeholders, and members.
• Strong technical acumen; learns new technology and systems quickly- e.g., Microsoft Office Suite, electronic charting, documentation systems.

Preferred:

• Master's in Social Work (MSW).
• Experience in health insurance setting beneficial.
• Previous experience working independently and managing an assigned caseload in a metrics-based environment. Knowledge of regulatory standards and regulations - e.g., URAC, NCQA, HIPAA, PHI, confidentiality.

Must be flexible and have the ability work weekend and/or holiday hours when needed on a rotational basis.

a. Provide social work expertise, working closely with a Health Services multi-disciplinary team to support care plan development and resource coordination across continuum of care for a select member population. Utilize critical thinking to recognize signs and symptoms of potential high-risk and complex conditions that warrant different or greater levels of support and proactively anticipate member needs for nurse intervention or collaboration.

b. In collaboration with Health Services multi-disciplinary team, facility, and member, facilitate transition of care planning needs to support patient safety and continuity of care. Proactively identify key issues and barriers to discharge; ensure development and facilitation of a timely discharge plan. Discuss the care needs with the member through supportive, focused intervention methods and effective planning techniques. Make referrals to Case Management for ongoing long-term needs.

c. Work with health care provider and community resource staff in a courteous and professional manner in gathering medical resources and services. Proactively identify barriers and gaps to care while designing, creating, and managing unique, individualized care plans that ensure members/providers have good communication channels, that members receive appropriate care, that potential duplication of services is avoided, and education is provided to help enable them to achieve the best possible health care goals.

d. Provide patient and provider education and actively participate in interdisciplinary rounds to develop and adjust the individualized member-centric care plan. Monitor referrals made to community-based organizations to support the member's care plan. Partner with members, members' families, health care providers and community resources to coordinate and facilitate the care and services needed.

e. As a member of the interdisciplinary care team, works as a liaison with internal resources, community agencies, and governmental programs in order to help patient access service. Collaborate with other clinical and nonclinical stakeholders, both internal and external to Wellmark, to provide optimal service and meet the needs of the member and coordinate care. Actively engage members as participants in their unique care management plan and educate on their personal accountabilities and expected outcomes. Advise on included benefits and services that are appropriate for their current medical status, and how those benefits and services can positively impact not only their medical status, but also the total cost of care.

f. Document activity and decisions accurately, consistently, and timely within the care management documentation system by following the standard work guidelines and policies to support internal and external processes, including documentation of potential avoidable days/ admission when medical necessity criteria are not met. Meet both quality assurance and production metrics as established for the care team.

g. Comply with regulatory standards, accreditation standards and internal guidelines. Using relevant technology tools, document care management activities accurately, consistently, and timely by following the standard work guidelines and policies to support internal and external processes. Comply with regulatory standards, accreditation standards and internal guidelines. Remain current and consistent with the specific standards pertinent to the Case Management team.

h. Other duties as assigned

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]