Social Worker - Utilization Management Team

Skip to Main Content CareersLog inSocial Worker – Utilization Management TeamShow All JobsApplyLocationRemote - Austin, TX, United StatesJob CategorySocial Worker, Utilization ManagementIndustryHealthcareEmployee TypeExempt - FTRequired DegreeMastersManage OthersNoMinimum Experience5 YearsDescriptionHarbor HealthSocial Worker – Utilization Management TeamAustin, TX  |  Utilization Management  |  Full-Time  |  RemotePOSITION OVERVIEWCandidate must reside in the Austin, TX area.The Social Worker supports the Utilization Management (UM) team by addressing psychosocial, behavioral health, substance use, and social needs that impact members' health outcomes and care utilization. This role focuses on identifying barriers to care, supporting members with behavioral health and substance use concerns, and addressing Social Determinants of Health (SDOH). The Social Worker collaborates with members, HHIC UM nurses, care managers, providers, and community organizations to ensure members receive coordinated, person-centered care and are connected to appropriate healthcare and community-based resources.POSITION DUTIES & RESPONSIBILITIESPsychosocial & Behavioral Health SupportConduct psychosocial assessments for HHIC (Harbor Health Insurance Company) members identified through UM reviews who may have behavioral health, mental health, substance use, or complex social needsIdentify psychosocial barriers that may affect treatment adherence, recovery, or access to servicesProvide support and care coordination for members experiencing behavioral health or substance use challengesCollaborate with behavioral health providers, substance use treatment providers, and primary care teams to support appropriate careAssist in identifying appropriate levels of care and support services for members when neededSocial Determinants of Health (SDOH) SupportAssess members for social needs such as housing instability, food insecurity, transportation barriers, financial hardship, and other social factors affecting healthConnect members to community resources, social service programs, and support servicesCoordinate referrals to community organizations, social service agencies, and recovery support programs as appropriateSupport members in navigating healthcare and community systems to access needed servicesCare Coordination & UM Team CollaborationCollaborate with UM nurses, the HHMG (Harbor Health Medical Group) Acute & Complex Care Team (ACT), and other resources, including pharmacy, to ensure comprehensive, holistic care for membersParticipate in case reviews and care planning discussions for members with complex needsAssist with member outreach, engagement, and education regarding available services and resourcesEngage in face-to-face interactions with providers and members to assess and support social work–related member needsSupport efforts to improve care coordination and address barriers that may impact healthcare utilizationDocumentation & ComplianceMaintain timely and accurate documentation in applicable UM and Care Management (CM) systems, e.g. PA Tracker Google Sheet, Athena EHR, etc.Ensure compliance with organizational policies, regulatory requirements, and privacy standardsTrack and report activities related to psychosocial interventions and community resource referrals as requiredDESIRED PROFESSIONAL SKILLS & EXPERIENCERequired:Active Social Work license (LMSW)At least five years' experience working with individuals experiencing behavioral health, substance use, or complex social needsReside in the Austin area and have knowledge of Austin-area community resources and social service systemsStrong communication, assessment, and care coordination skillsAbility to support occasional in-person interactions with providers and members in the Austin areaPreferred:Experience in managed care, health plans, or utilization managementFamiliarity with Social Determinants of Health (SDOH) screening and interventionsExperience working with diverse or...