Your Role

The Social Services Representative, Advanced will report to the Supervisor, Social Services. In this role you will provide telephonic social services support and resource referrals for high acuity Blue Shield Promise members, in addition to administrative support to the Social Services Management Team. The Social Services Representative regularly reaches out to members and/or family members with the goal of assessing social service needs, and coordinating support aimed towards improving member quality of care. The Social Services Representative coordinates with team members and other internal departments, as well as providing the first line of telephonic response for incoming calls to the Social Services department.

Your Work

In this role, you will:

• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Conduct telephonic social determinants of health needs assessment with high acuity members to address social barriers and care gaps
• As a mandated reporter, files and follows-up on reports made to the appropriate government agency (eg, Adult Protective Services, Child Protective Services, etc.)
• Provide members and/or family members with care coordination, referrals and linkage to Health Plan resources and community agencies
• Document screenings, assessments, referrals and case notes in the electronic case management and tracking systems within the established department guidelines
• Provide telephonic support to member and/or family members following their discharges from hospitals and other medical facilities.
• Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently
• Prepare and complete logs and reports as needed for meetings and audits
• Any other assigned duties

Your Knowledge and Experience

• High School Diploma required
• Bachelor's Degree in Social Work or equivalent preferred
• Requires broad knowledge of operational systems and practices typically gained through extensive experience and/or education
• Typically, requires minimum of 5 years of experience. May require vocational or technical education in addition to prior work experience
• Minimum two (2) years of experience with Medi-Cal managed care including Cal MediConnect and Medicare preferred
• Knowledge of governmental and private organizations, resources in the community, laws, regulations and policies preferred
• Experience working with or for a manage health care plan preferred
• Effective time management skills and ability to define and act on priorities efficiently preferred
• Skill in establishing rapport with members. Ability to plan and execute work effectively. Ability to express ideas clearly and concisely preferred
• Excellent analytical skills. Excellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, and participating provider groups preferred

Pay Range:

The pay range for this role is: $ 20.82 to $ 29.15 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.