ICM Social Work Community Navigator

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  JOB DUTIES
  

The ICM Social Work Coordinator supports Intensive Case Management (ICM) Social Workers and Nurses by providing non-clinical care coordination, referral and authorization processing, and service navigation for patients with moderate to high psychosocial and behavioral health needs. This role focuses on timely access to services, safe discharge planning, and prevention of unnecessary emergency department visits and hospital readmissions, particularly for high-risk and Medicare Advantage populations.

Key Responsibilities

• Coordinate and process urgent, routine, pre-service, and retro authorization requests in compliance with UCLA Medical Group, CMS, and health plan guidelines
• Prepare and manage referrals, review pending claims, and support approval or denial determinations
• Provide non-clinical care coordination for ICM-enrolled and high-risk patients across inpatient, SNF, outpatient, and post-acute settings
• Monitor hospital and SNF admissions and discharges; conduct post-discharge outreach and screenings
• Coordinate transitions of care, including transportation, DME, home health, and post-acute services
• Collaborate closely with ICM nurses, social workers, providers, hospitals, SNFs, and external programs
• Maintain accurate documentation and tracking within the electronic medical record and referral systems
• Support quality improvement, data collection, and program operations as needed

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  JOB QUALIFICATIONS
  

Required:

• High school diploma, GED or equivalent
• Experience processing Inpatient and ambulatory Managed Care referrals
• Ability to multi-task, work with frequent interruptions, and meet deadlines. Must be detailed, oriented, attentive, organized, and able to follow directions
• Proficient computer skills including working knowledge of Microsoft Excel and Word
• Ability to communicate thoughts and information clearly and succinctly in writing as well as verbally
• Ability to operate a wide variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter, scanners and mailing equipment

• Minimum of 2 years’ experience working in a Managed Care Case Management and care coordination environment