Harbor Health
Social Worker – Utilization Management Team
Austin, TX | Utilization Management | Full-Time | Remote
POSITION OVERVIEW
Candidate must reside in the Austin, TX area.
The Social Worker supports the Utilization Management (UM) team by addressing psychosocial, behavioral health, substance use, and social needs that impact members' health outcomes and care utilization. This role focuses on identifying barriers to care, supporting members with behavioral health and substance use concerns, and addressing Social Determinants of Health (SDOH). The Social Worker collaborates with members, HHIC UM nurses, care managers, providers, and community organizations to ensure members receive coordinated, person-centered care and are connected to appropriate healthcare and community-based resources.
POSITION DUTIES & RESPONSIBILITIES
Psychosocial & Behavioral Health Support
Conduct psychosocial assessments for HHIC (Harbor Health Insurance Company) members identified through UM reviews who may have behavioral health, mental health, substance use, or complex social needs
Identify psychosocial barriers that may affect treatment adherence, recovery, or access to services
Provide support and care coordination for members experiencing behavioral health or substance use challenges
Collaborate with behavioral health providers, substance use treatment providers, and primary care teams to support appropriate care
Assist in identifying appropriate levels of care and support services for members when needed
Social Determinants of Health (SDOH) Support
Assess members for social needs such as housing instability, food insecurity, transportation barriers, financial hardship, and other social factors affecting health
Connect members to community resources, social service programs, and support services
Coordinate referrals to community organizations, social service agencies, and recovery support programs as appropriate
Support members in navigating healthcare and community systems to access needed services
Care Coordination & UM Team Collaboration
Collaborate with UM nurses, the HHMG (Harbor Health Medical Group) Acute & Complex Care Team (ACT), 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) systems, e.g. PA Tracker Google Sheet, Athena EHR, etc.
Ensure compliance with organizational policies, regulatory requirements, and privacy standards
Track and report activities related to psychosocial interventions and community resource referrals as required
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
Required:
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:
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
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
At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!
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.
