Social Services Representative, Advanced

Your Role

The Social Services Representative, Advanced provides telephonic social services support and resource referrals to Blue Shield D-SNP members, in addition to administrative support to the social service team and Manager/Supervisor. The Social Services Representative, Advanced is regularly reaching out to members and/or family members with the goal of assessing social service needs, and coordinating support aimed towards improving member quality of care. The Social Services Representative, Advanced coordinates with team members and other internal departments, as well as provides the first line of telephonic response for incoming calls to the Social Work department.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Establish trusting relationships with members while providing person-centered support and services
• Conduct telephonic social determinants of health needs assessment with high acuity members to address social barriers and care gaps
• Provide members and/or family members with care coordination, referrals and linkage to Health Plan resources and community agencies
• Provide telephonic support to members and/or family members following their discharges from inpatient facilities
• Document assessments, referrals and case notes in the electronic case management and tracking systems within the established department guidelines
• File and make necessary follow-up on mandated reporting, e.g. Adult Protective Services, Child Protective Services, etc.
• Actively participates in Interdisciplinary Team Meetings and provides updates on member’s ongoing needs and progress, and intervention recommendations
• Provide telephonic support to member and/ or family members following their discharges from hospitals and other medical facilities.
• Coordinates services with State and community programs on behalf of the member, particularly when the member is unable to effectively do so independently.
• Prepares logs and reports as needed for meetings and audits
• Any other assigned duties

Your Knowledge and Experience

• Requires a High School Diploma and a broad knowledge of operational systems and practices typically gained through extensive experience and/or education
• Bachelor’s Degree in Social Work or equivalent preferred
• Requires minimum of 5 years of experience. May require vocational or technical education in addition to prior work experience
• Minimum 2 years of experience with Medi-Cal managed care including Cal MediConnect and Medicare
• Required experience with managing electronic health records and documenting in clinical case management systems.
• Required excellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, participating provider groups, and community-based organizations.
• Desired knowledge of governmental and private organizations, resources in the community, laws, regulations, and policies
Experience working with or for a managed health care plan

Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

ABOUT THE TEAM
About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.