JOB SUMMARY

Provides Disease Management (DM) services to TRICARE beneficiaries. The Social Worker – Disease Management collaborates with the clinical team to consult and collaboratively support the assessment, planning, implementation, coordination, monitoring and evaluation the beneficiary’s health and psychosocial needs with a focus on empowering the beneficiary to successfully manage their medical, behavioral and psychosocial needs related to their chronic condition. The SW will partner with the interdisciplinary care team to identify appropriate care to prevent complications related to chronic conditions and minimize the risk of potential exacerbation through the use of evidence-based condition-specific tools and support. This role requires the individual to contribute to care planning activities in collaboration with internal clinicians, providers, patients, families as appropriate and assesses the effectiveness and outcomes to improve individual health status.

IT’S WHO WE ARE. IT’S WHAT WE DO.

Do you have a passion for serving those who served?

KEY RESPONSIBILITIES

• Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiary’s overall goals of care.
• Collaborate with the clinical to contribute to the whole-person plan of care by incorporating behavioral and psychosocial assessment findings utilizing evidence-based guidelines, clinical reasoning and clinical practice guidelines.
• Provide education and coaching support specific to the beneficiary’s behavioral and psychosocial needs to prevent to support management of their chronic condition.
• Manage activities necessary to ensure appropriate utilization and access to medical and behavioral resources, while maintaining optimal standards of care.
• Review, identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
• Participates in the development of measurable outcomes, ensures measure are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
• Assesses high risk factors, acuity and need for other TRICARE services and resources.
• Facilitate transfer of beneficiary between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.
• Adhere to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer tim