[Hiring] Case Management Social Services Coordinator I @Personify Health

Role Description

Ready to guide members through their toughest moments and turn complex needs into clear plans?

Some of our members are facing the hardest stretch of their lives: a catastrophic diagnosis, a hospital discharge with no plan, or a pile of needs no one has connected. You’re the person who picks up the phone and makes sense of it all. By assessing the whole person, building care plans that fit, and linking members to the right providers and community resources, you improve outcomes while keeping the total cost of care in check. Your documentation and quality work also keep us ready for URAC and NCQA review. When you do this well, members get real support and the organization earns the trust that keeps our programs strong.

What You’ll Actually Do:

• Guide members by phone and virtually.
• Manage short- and long-term cases in line with company policies, established guidelines, and industry criteria, with guidance available when complex barriers arise.
• Conduct biopsychosocial assessments covering physical, emotional, psychosocial, spiritual, environmental, and financial needs, so every care decision starts with the full picture.
• Use claims-processing tools to analyze paid claims, identify risk indicators, and determine program eligibility.
• Develop individualized plans for standard and catastrophic cases with measurable short- and long-term goals, then monitor interventions, evaluate effectiveness, and document outcomes.
• Coordinate resources, support care transitions, and refer members to wellness programs, behavioral health programs, and community-based services so they get quality care and avoid unnecessary costs.
• Maintain consistent contact with members, caregivers, providers, employers, and the interdisciplinary team throughout the continuum of care.
• Implement and document cost-management strategies, including monthly case reviews and cost-avoidance data.
• Keep accurate, complete records in El Dorado, UM Web/Health Notes, and other required systems, prepare 30-day interval updates for every case-managed member, and maintain site-specific files in line with HIPAA and confidentiality rules.
• Meet URAC and NCQA requirements, pass external audits, complete annual trainings, and hit daily, weekly, and monthly productivity, quality, and turnaround standards.
• Support department operations and implementations, participate in team meetings and case discussions, and bring forward ideas for process improvement.

Qualifications

• Bachelor’s or Master’s degree from an accredited Social Work program.
• Minimum 2 years of acute healthcare experience.
• Experience with psychosocial assessment, care planning, and service navigation for vulnerable or high-risk populations.
• Working knowledge of URAC and NCQA standards and HIPAA confidentiality requirements.
• Knowledge of medical claims and ICD-10, CPT, and HCPCS coding.
• Foundational clinical judgment, social work principles, and motivational interviewing.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Basic computer literacy, proficient typing, and the ability to work across multiple screens.
• Proficiency in Teams (on and off camera), SharePoint, shared drives, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Smartsheet, and a phone system with headset; additional programs may apply based on job duties.
• Full system proficiency expected after training and a 1.5-month ramp (3 months total).

Benefits

• Competitive base salary and benefits effective day one.
• Comprehensive medical and dental through our own health solutions (yes, we use what we build).
• Paid Time Off—rest and recharge time is non-negotiable.
• Mental health support, retirement planning, and financial protection.
• Professional development with clear career progression and learning budgets.
• Mission-driven culture where diverse perspectives drive real impact on people's health.