Title: Clinical Social Worker
FLSA Status: Non-exempt
Prepared Date: March 2009
In collaboration with an interdisciplinary team, the clinical social worker (CSW) will be involved
in the delivery of approved programs that serve the Medicare population as directed by FMQAI’s
contract requirements. The CSW will also work with team members and CMS to accomplish the
goals stated within the current scope of work and within the parameters of the QIO contract.
Essential daily functions will consist of assisting beneficiaries who have concerns/complaints
about the quality of the healthcare services provided to them, providing case management with
an emphasis on counseling, community agency referral and crisis/bereavement support and
assisting team with medical record review.
1. Reviews and triages incoming complaints to determine appropriate intervention
2. Assists beneficiaries by utilizing appropriate conflict resolution techniques and providing
referrals to appropriate community/agency resources
3. Empowers beneficiaries and providers to improve their communication with regard to
quality of care concerns
4. Promotes early resolution of complaints consistent with QIO case-review process
5. In collaboration with interdisciplinary team, continuously improves the measures in place
which impact beneficiary satisfaction within the complaint process
6. Advocates for beneficiary self-determination and for system-wide improvement in health
7. Assists beneficiaries in crisis or bereavement utilizing the strengths of individuals and
their families to restore their capacity for optimal emotional and physical health
8. Acts as communication liaison with beneficiaries involved in the case-review process
9. Demonstrates strict adherence to FMQAI privacy policies
Accountable for the timeliness, completeness, accuracy and quality of all assigned functions
1. Able to work independently and maintain a good working relationship with clients and co-
2. Sensitive to individuals and their respective problem(s).
3. Be emotionally mature and objective and provide psychosocial support to FMQAI’s internal
and external clients
4. Run support group(s), advise the elderly population of possible services available to them
and coordinate and monitor these services.
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5. Ability to communicate face-to-face and through telecommunications and written
correspondence with individuals using the English language.
6. Ability to understand presentation information.
7. Ability to travel occasionally by motor vehicle and/or aircraft.
8. Ability to adhere to established company confidentiality policies
Must be able to communicate with beneficiaries, providers, internal/external customers and third
party vendors on a daily basis in addition to demonstrating professional ethics and sensitivity to
cultural diversity issues. Bilingual (English/Spanish) communication skills are strongly desired
Must possess the ability to respond effectively and sensitively to beneficiaries’ inquiries and
complaints and to articulate to team members the nature and scope of beneficiaries’ needs. A
high degree of cultural competence and sensitivity to the diverse backgrounds that will be
encountered and effective and respectful interpersonal communication skills are essential. Must
demonstrate attention to accuracy and coherence in all verbal and written communication
Must be able to read, analyze and interpret medical records and government regulations; be
computer literate and able to type proficiently, and be able to navigate various CMS-approved
databases. A proficiency in Microsoft Office applications (Word, Excel and PowerPoint) is
strongly desired. Must be able to define and triage problems appropriately by collecting data,
establishing facts and drawing valid conclusions. Experience with senior population issues is
Must have basic mathematical skills; be able to add, subtract, multiply and divide in all units of
measure, using whole numbers, common fractions and decimals.
Must be able to define problems, collect data, establish facts and draw valid conclusions.
EDUCATION AND/OR EXPERIENCE
A Master’s degree in Social Work from an accredited college or university is required.
Licensure in clinical social work is preferred. Three to five years recent clinical experience is
CERTIFICATES, LICENSES, REGISTRATIONS
Maintain an active social work license in the State of Florida.
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The physical demands described here are representative of those that must be met by an associate
to successfully perform the essential functions of this position. Reasonable accommodations
may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this position, the associate is regularly required to use hands and
fingers to handle and feel; to reach with hands and arms and talk and hear. The associate
frequently is required to stand, walk, and sit. The associate must regularly lift and/or move up to
10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required
by this job include close and distance vision, color vision, peripheral vision, depth perception
and ability to adjust focus.
The work environment characteristics described here are representative of those an associate
encounters while performing the essential functions of this position. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential
functions. The noise level in the work environment is usually moderate.
This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements,
efforts, or working conditions associated with the position. While this is intended to be an
accurate reflection of the current position, management reserves the right to revise the position
or to require that other or different tasks be performed when circumstances change (e.g.,
emergencies, changes in personnel, work load, rush jobs or technological developments).
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