Job Description

Employment Type: Full-time

Position Overview

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Program Overview: Join our Aetna team as we lead the way in providing exceptional care to dual eligible populations! This role involves 50-75% travel. You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. Through compassionate engagement and effective communication, we work collaboratively with members, healthcare providers, and community organizations to address the comprehensive healthcare and social needs of our members. Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country.

Position Summary: As a field Social Worker, you will play a vital role in the member-centered care planning process alongside the other core care team members. Your responsibilities will include:

• Conducting field visits to the member’s home, community locations, medical facilities, and other locations.
• Completing care management focused assessments.
• Setting member-centered goals.
• Identifying barriers and strategies to address them.
• Establishing, monitoring, and adapting interventions to achieve member goals.

Fundamental Components

• Focus on enhancing quality of care, ensuring compliance, improving outcomes, and reducing costs.
• Develop and implement strategies to coordinate and integrate post-acute and long-term care services, preventing exacerbations and unnecessary custodial placements.
• Perform initial and ongoing assessments for members enrolled in the Long-Term Care Program and other care initiatives.
• Utilize social work principles and strategies to address the social determinants of health within each member’s individualized care plan.
• Collaborate and facilitate ongoing communication with providers, primary care physicians, Medical Directors, pharmacists, and care management staff to discuss member status and progress toward goals.
• Advocate for members to ensure they receive all necessary care covered by their benefit plans and available through Medicaid and community resources.
• Build relationships with hospital social workers and community resources, leveraging data to ensure effective management of catastrophic, acute, and chronically ill members, aiming for appropriate utilization and reduced lengths of stay.
• Assist in identifying and reporting potential quality improvement opportunities.
• Direct social work interventions, including psychosocial assessments, follow-ups, in-home or facility assessments, documentation of issues and interventions, and facilitating access to a continuum of care through appropriate referrals.

Required Qualifications

• Residency: Candidate must reside in Carroll County, Georgia (GA).
• Experience: 2+ years of experience in medical social work or case management.
• Licensure: Candidate licensure must comply with requirements in the state where job duties are performed.
• Travel: Ability to travel within a designated geographic area for in-person case management activities (Travel expenses are reimbursed in accordance with the company travel reimbursement policy).
• Technical Skills: Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Social Worker role.
• Work Environment: Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually. Access to a private, dedicated space to conduct work effectively to meet the requirements.