Job Description

Description

JOB DESCRIPTION: The Social Work Case Manager (SW CM) is responsible for patient care coordination from admission through discharge; ensuring smooth transitions of care as the patient is discharged from the hospital setting, ensuring and facilitating high quality clinical and cost outcomes, procuring and securing post-acute services, coordinating and advocating for patients and families with both internal and external stakeholders, and identifying and addressing potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement. The SW CM will begin the process of care coordination at the time of the patients admission by completing a thorough admission assessment and/or psychosocial assessment which will allow for a timely and accurate capture of information as well as foster the ability to begin working towards a discharge plan. The SW CM is an integral part of the interdisciplinary care team who is required to attend rounds, care conferences, and/or care team meetings. The SW CM will act as a representative of both the hospital care team and the patient/family in an effort to balance patient/family choice and projected care coordination needs with the ability to execute such services. The SW CM will work with the hospital care team and the patient/family in order to plan and implement the best possible plan for the patient while taking various factors, limitations, and patient/family preference into consideration. The SW CM will identify and recommend post-acute services and will complete referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family as well as the care team. Through continuous assessment and review, the SW CM will apply critical thinking to ensure alignment and appropriateness of post acute services as the patient clinically progresses throughout their stay. Ultimately, the SW CM is responsible for ensuring the discharge plan is aligned to be executed with the patients medically cleared for discharge date as well as the projected length of stay as provided by the payor. The SW CM identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The SW CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee. It is the role of the SW CM to educate patients/families as well as the care team as it relates to post acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices and available resources. The SW CM provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations. The SW RN responds to suspected violent, assault, abuse and/or neglect cases in accordance with social work professional ethics. The SW CM must communicate confidently, effectively, and therapeutically while being assertive and conveying an impression which reflects favorably upon the organization. In collaboration with Utilization Review, the SW CM will initiate and facilitate discussions with the payors to act as an advocate on behalf of the patient and hospital in an effort to reduce non-covered, non-authorized, or denied services. The SW CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures as it pertains to Discharge Planning and Care Coordination. The SW CM will ensure compliance with all regulatory requirements as it relates to Government and Commercial Payors. The SW CM will ensure compliance with all third-party payers and federal and state regulatory agencies. The SW CM will ensure proper use of Case Management Systems and workflows.

MINIMUM QUALIFICATIONS: Must have a Masters in Social Work from an accredited Institution. Two (2) years recent healthcare experience preferred, experience in Acute Care setting preferred. LMSW license in the state of Georgia required. Must have working knowledge of software/Eemr applications. ACM, CCM preferred. Must meet all quality and productivity expectations and successfully complete yearly competencies. Must obtain 4 CEU credits per year, related directly to core job functions, in addition to yearly competencies. Must actively participate in process improvement initiatives by sharing thoughts and idea in a constructive manner. For Behavioral Health job locations, Master\'s degree in Psychology, Counseling, or related field from an accredited institution will be accepted in lieu of Master\'s degree in Social Work and licensure as LAPC in the state of Georgia will be accepted in lieu of LMSW to meet the minimum job requirement.

PHYSICAL REQUIREMENTS (Medium): 20-50 lbs; 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 50 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Emory Healthcare