Case Mgmt Social Services Coordinator I

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

Case Management Social Services Coordinator (Level I)

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

Why This Role Matters

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.

- Assess the whole person: Conduct biopsychosocial assessments covering physical, emotional, psychosocial, spiritual, environmental, and financial needs, so every care decision starts with the full picture.

- Spot risk in the data: Use claims-processing tools to analyze paid claims, identify risk indicators, and determine program eligibility.

- Build person-centered care plans: Develop individualized plans for standard and catastrophic cases with measurable short- and long-term goals, then monitor interventions, evaluate effectiveness, and document outcomes.

- Advocate for members: 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.

- Keep the care team connected: Maintain consistent contact with members, caregivers, providers, employers, and the interdisciplinary team throughout the continuum of care.

- Drive cost-smart outcomes: Implement and document cost-management strategies, including monthly case reviews and cost-avoidance data.

- Document with precision: 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.

- Stay audit-ready: Meet URAC and NCQA requirements, pass external audits, complete annual trainings, and hit daily, weekly, and monthly productivity, quality, and turnaround standards.

- Strengthen how we work: Support department operations and implementations, participate in team meetings and case discussions, and bring forward ideas for process improvement.

Qualifications

What You Bring to Our Team

Education & Experience:

• 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

Technical Skills:

• 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

The Highlights:

• 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

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a base salary range of $26.00-$28.00 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.

Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to . View all legitimate openings at personifyhealth.com/careers.

Originally posted on Himalayas