Post Acute Care Social Worker - eviCore- Remote - Cigna

Utilizing telephonic outreach, the Social Worker performs clinical and operational processes related to Post-Acute Care services, including but not limited to long-term acute care, skilled nursing, inpatient rehab, home health care, DME, care management, and utilization review. The social worker addresses health equity and social determinants of health concerns and proactively addresses top admission-driving diagnoses that may impede the patient's ability to adhere to their medical care plan by leveraging knowledge of plan benefits and community resources.

The Social worker may support various regions and provide cross-coverage between regions. This varies by market and panel size. Social worker must have the ability to work independently and effectively communicate to internal and external customers. In addition to supporting our patients, the social workers support other disciplines and provide consults, training, and education as appropriate.

Key Responsibilities

• Interfaces with the care team to facilitate effective communication, referrals, and development of an integrated care plan
• Collaborates with the care team to achieve identified patient outcomes
• Coordinates the treatment plan to accommodate the health service needs of the member, incorporating community resources when available
• Attends and actively participates in care team meetings
• Balances business needs with patient advocacy
• Builds solid working relationships with internal team members, matrix partners, key functional areas, customers and providers
• Provides decision support where multiple treatment options are available
• Identifies high-risk/high-cost patients for social service intervention.
• Initiates contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment plan.
• Other Duties as assigned.

Job Related Skills:

• Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills
• Strong skills in the following areas: teamwork, assessment complex issues, ability to recommend changes and resolve problems through effective decision making
• Knowledge of managed care and utilization review requirements and procedures.
• Ability to work within changing business environment and balance business needs with patient advocacy
• Management of local community based resources that may meet needs of patients
• Strong personal computer skills, EMR experience, MS word, Excel, Outlook experience, and Internet research desired

Qualifications

• Must have an active and unrestricted LMSW or LCSW in state of residence.
• Three more years' experience in a Home health, SNF, and/or rehab experience preferred
• Preferred Qualifications (Experience)
• Clinical experience in acute care, a clinical setting, or in case management including experience/expertise in one of the following selected fields of social work:
• Hospital/Community Coordination of Care
• Skilled Nursing/Rehabilitation/ Long Term Care
• Managed Care/Geriatric Social Work
• Home Health/Hospice/Palliative Care
• Communicates Effectively- Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences
• Manages Ambiguity- Operating effectively, even when things are not certain or the way forward is not clear
• Manages Complexity- Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems
• Situational Adaptability- Adapting approach and demeanor in real time to match the shift in demands of different situations
• Collaborates - Building partnerships and working collaboratively with others to meet shared objectives

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 55,900 - 93,100 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.