Social Worker – Utilization Management Team
Harbor Health
POSITION OVERVIEW
*Candidate should reside in San Antonio
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 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 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) systems (e.g., PA Tracker Google Sheet, Athena EHR).
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 Qualifications
Active Social Work license (LMSW).
At least five years of experience working with individuals experiencing behavioral health, substance use, or complex social needs.
Reside in the San Antonio area and have knowledge of San Antonio-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 San Antonio 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
WHAT WE OFFER
Competitive salary and benefits package
Generous PTO
10 paid holidays
Medical, Dental, and Vision Insurance
401(k) Investment Plan
Professional development and growth opportunities
A transparent and unique culture
Collaborative and dynamic work environment
COMPANY OVERVIEW
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!
EQUAL EMPLOYMENT OPPORTUNITY
Harbor Health is an Equal Opportunity Employer. We celebrate diversity and are committed to building an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.
