Medical Social Associate

Position Summary

The DSCC Core/Connect Care (Associate) provides care coordination services to families eligible for these two programs. Under the direction of the regional manager and assistant directors, the position is responsible for knowing and abiding by specific program contractual requirements. The Medical Social Associate is expected to engage and develop strong partnerships with families through completing comprehensive assessments and person-centered care plans, monthly interactions, and coordination of resources.

Duties

Responsibilities

• Under the direction of the regional manager, performs active care coordination services by completing comprehensive health assessments, identifying families' strengths, and developing a person-centered care plan.
• Facilitates 30-day ( or as needed) monitoring of the person-centered care plan, assesses/determines status change, prioritizing unmet needs and location of resources.
• Conduct and document in-person visits at home (every 6 months or as needed) or in other appropriate settings like schools or hospitals.
• Completes consistent and timely documentation (within 48 hours) to ensure compliance case record compliance as established by procedures.
• Join and participate in Medicaid managed care clinical rounds, or other interdisciplinary care team meetings with participants’ providers, family members, or school teams.
• Join and participate in DSCC multidisciplinary meetings as needed.
• Engage as necessary with the transition of the care team to promote effective discharge planning. Educate, support, and connect families with resources for a seamless age transition.
• Provide close collaboration with MCO teams for those participants that are co-managed (e.g., waiver recipients).
• Identify/escalate and facilitate internal team meetings on participants facing challenging behavioral/social determinants or clinical factors impacting their well-being.
• Identifies critical incidents and collaborates with all involved parts for resolution.
• Utilize a culturally – competent approach as guided by the university to support families’ cultural values and traditions.
• Utilize as necessary interpreter language line and accommodation resources based on the university’s Americans with Disability Act (ADA) guidelines, such as American Sign Language (ASL).
• Complies with the University, Division, and Regional Office policies, and procedures.
• Active participation in post-records reviews and completion of recommended remediation within expected timeline.
• Contribute to quality improvement initiatives, including but not limited to attendance at quality huddles and provision of recommendations as needed.
• Assist families and caregivers with the coordination of medical services, required treatments, supplies/equipment, and environmental modifications.
• Assists families with private/public health insurance through effective benefits management practices for recipients.
• Identify financial needs and assist with the completion of DSCC financial application, and annual redetermination.
• Competent collection of documentation to support administrative/prior approvals for Core eligible services, and utilization of other resources like gift funds. The list of responsibilities is not all-inclusive and could be extended to include other obligations, special projects, or tasks as indicated by contractual requirements, DSCC leadership, and management at any time. Perform other related duties and participate in special projects as assigned.