Social Worker – Utilization Management Team

• 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.