Job Details

Medical Social Worker

  2019-04-22     Central California Alliance for Health     Salinas  

Utilization Management Medical Social Worker


We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 350,000 members in Santa Cruz, Monterey and Merced counties.


Participating in the Utilization Management (UM) Concurrent Review interdisciplinary team and care transitions assignments responsible for the psychosocial management of members in long term care placements and members newly discharged from an acute care of skilled care setting that are at high risk for readmission. You will also work with, and provide assistance and education, to members, providers, external agencies and internal departments on UM Concurrent Review programs and participate in quality improvement studies to continually evaluate program effectiveness and promotion of quality-driven, cost-effective and achievable goals and outcomes for members.


The Utilization Management Concurrent Review Team Social Worker has unique responsibilities with a variety of roles and tasks that create a diverse work experience. This position is responsible for seeing members in the inpatient acute setting  as well as the skilled nursing setting. The MSW works collaboratively with the entire team of concurrent review nurses, focusing on identifying the needs and barriers that the member may face upon discharge from a facility.



  • Be bilingual in English/Spanish
  • Master's degree in Social Work
  • Have current and unrestricted California licensure as a Licensed Clinical Social Worker
  • Have work experience as a Medical Social Worker
  • Have working knowledge of Milliman Care Guidelines (MCG) and other tools utilized in the level of care determination process


  • Knowledge of:
    • The principles and practices of case management, including assessment, care/treatment planning, discharge planning and documentation
    • The principles and practices of care transitions and coordination
    • Governmental and non-profit resources utilized to assist members in achieving goals
    • The utilization of evidence-based practice guidelines, including as applied to development of a plan of care
  • Ability to:
    • Exercise strong critical thinking and problem solving skills
    • Effectively interview members to determine their strengths, problems, prognosis, functional status, goals, and needs for specific services and resources, and to establish short- and long-term goals
    • Create, document, and implement intervention plans
    • Competently navigate computerized Electronic Health Records (EHRs)
  • Education and Experience:
    • Bachelor’s degree in Social Work and two years (or a Master’s degree and one year) of Social Work experience in an acute care setting, community agency or managed care environment; or an equivalent combination of education and experience may be qualifying


  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 11 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • EV Charging Stations

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship

Do not contact this company in solicitation of any product or service.

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