Social Worker (Field Must reside in Miami Dade County, FL)

Implements initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs under limited supervision to determine course of treatment.Applies in-depth knowledge of case management concepts, principles, and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes.
Communicates updates and facilitates discussion with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of patients internally and externally.Identifies opportunities to ensure the member receives all the necessary care allowed under the member's benefit plan in home or community settings.
Provides information, resources, and education on social issues, mental health, and available services to raise awareness and empower individuals and communities.Develops complex, innovative programs designed to reduce admissions for acute and chronic members, increase community integration, and improve health outcomes for enrolled patients and outside individuals.
Coaches more junior colleagues in techniques, processes, and responsibilities of social work to improve capacity.Collaborates with community members, organizations, and policymakers to create opportunities for clients, address community issues, or raise awareness for specific issues.

Essential Qualifications
Basic awareness of problem solving and decision making skills.
Basic awareness of digital literacy skills.
Basic knowledge of medical terminology.
Ability to deal tactfully with customers and community.
Ability to handle sensitive information ethically and responsibly.
Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients. Program Overview

This role will be 75% travel within a 50 mile radius- Miami Dade County.

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary

The Social Worker participates in the care planning process in collaboration with the Care Manager, to include the following actions: assessment, goal setting, establishing interventions related to goals, identifying barriers and strategies to address, monitoring success of the interventions, evaluating the success of the overall care plan and reporting outcomes. Fundamental Components

• Care Management activities are conducted through a combination of telephonic and face to face interactions which include visits to member homes, in the community, facilities and/or provider locations
• Care management activities will focus on quality of care, compliance, outcomes and decreasing costs
• Responsible for developing and carrying out strategies to coordinate and integrate post-acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care
• Performs initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or care programs
• Applies social work concepts, principles, and strategies in addressing the social determinants of health needs in members individualized care plan
• Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of members and progress towards goals
• Serves as a member advocate to ensure the member receives all the necessary care allowed under the member's benefit plan and as available through Medicaid benefits and/or other community resources
• Develops relationships with hospital social workers and community resources and utilizes available data to assure appropriate care management of catastrophic, acute, and chronically ill members with the goal of appropriate utilization, decreased length of stay, and preventable emergency room utilization
• Assists in the identification and reporting of potential quality improvement issues
• Directs social work interventions including performing psychosocial assessment of the populations, telephone follow up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate information and referral

Required Qualifications

• Candidate must reside in Miami Dade County, FL
• Must possess reliable transportation and be willing and able to travel up to 75% of the time. Mileage is reimbursed per our company expense reimbursement
• Must possess active and unrestricted LMSW/LCSW licensure in the state of Florida
• Minimum of 2+ years experience in medical social work or case management

Preferred Qualifications

• Bilingual (English + Spanish)
• Ability to multitask and manage complex cases
• Experience in member crisis management
• Proficient in Microsoft Office applications

Education

• Master's Degree in Social Work
• LMSW or LCSW in the state of Florida

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$21.10 - $43.78This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 04/13/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.