Social Worker - Utilization Management Team

Social Worker – Utilization Management Team 

COMPANY OVERVIEW

At Harbor Health, we’re transforming healthcare in Texas through collaboration and innovation. We’re seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model.  If you’re ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

POSITION OVERVIEW

*Candidate should reside in Austin

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 & RESPONSIBILITIES

Psychosocial & Behavioral Health Support

• Conduct 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 needs.
• Identify psychosocial barriers that may affect treatment adherence, recovery, or access to services.
• Provide support and care coordination for members experiencing behavioral health or substance use challenges.
• Collaborate with behavioral health providers, substance use treatment providers, and primary care teams to support appropriate care.
• Assist in identifying appropriate levels of care and support services for members when needed.

Social Determinants of Health (SDOH) Support

• Assess members for social needs such as housing instability, food insecurity, transportation barriers, financial hardship, and other social factors affecting health.
• Connect members to community resources, social service programs, and support services.
• Coordinate referrals to community organizations, social service agencies, and recovery support programs as appropriate.
• Support members in navigating healthcare and community systems to access needed services.

Care Coordination & UM Team Collaboration

• Collaborate with UM nurses, the HHMG (Harbor Health Medical Group) Acute & Complex Care Team (ACT) team, and other resources, including pharmacy, to ensure comprehensive, holistic care for members.
• Participate in case reviews and care planning discussions for members with complex needs.
• Assist with member outreach, engagement, and education regarding available services and resources.
• Engage in face-to-face interactions with providers and members to assess and support social work–related member needs
• Support efforts to improve care coordination and address barriers that may impact healthcare utilization.

Documentation & Compliance

• Maintain timely and accurate documentation in applicable UM and Care Management (CM) e.g. PA Tracker Google Sheet, Athena EHR, etc. systems.
• Ensure compliance with organizational policies, regulatory requirements, and privacy standards.
• Track  and report activities related to psychosocial interventions and community resource referrals as required.

REQUIRED QUALIFICATIONS

• Active Social Work license (LMSW)
• At least five years experience working with individuals experiencing behavioral health, substance use, or complex social needs.
• Reside in the Austin area and have knowledge of Austin-area community resources and social service systems.
• Strong communication, assessment, and care coordination skills.
• Ability to support occasional in-person interactions with providers and members in the Austin area.

PREFERRED QUALIFICATIONS

• Experience in managed care, health plans, or utilization management.
• Familiarity with Social Determinants of Health (SDOH) screening and interventions.
• Experience working with diverse or high-risk populations.
• Knowledge of Texas social service programs for members in need  both local and state-wide preferred
• Familiarity with NCQA processes and requirements

Key Competencies

• Member-centered and trauma-informed approach
• Behavioral health and substance use awareness
• Resource navigation and community engagement
• Interdisciplinary collaboration
• Cultural competency
• Problem solving and advocacy
• Motivational interviewing and effective communication – building trust and encouraging member engagement 
• Relationship-building and rapport development – establishing supportive, lasting connections 
• Empowerment and self-advocacy support – guiding members to make informed decisions about their care

Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.