Care Management Specialist - Behavioral Health - Day

WellSpan Health•Chambersburg, PA

11d•Onsite

About The Position

Provides assessment and coordination of care for patients from admission through discharge by maximizing available internal and external resources to reduce length of stay and improve quality of care. This includes assessing, planning, implementing, coordinating, and evaluating health and community related services to meet patient/family physical, psychosocial, vocational and health needs in a cost effective, outcomes oriented and timely manner.

Requirements

Bachelors Degree In Social Work but Inpatient Behavioral Health may have Bachelor’s degree in Psychology and Inpatient Rehabilitation may have bachelor's degree in human services.
Masters Degree In social work (or Psychology for inpatient behavioral health).
2 years Relevant experience.
Data analysis.
2 years Experience in a behavioral health setting for a Behavioral Health Unit.
Heartsaver CPR/AED Upon Hire.
Excellent clinical knowledge and be able to perform assessments and evaluate services, and display excellent interpersonal and leadership competence in order to interact effectively with the patient, the patient’s family, community service providers/agencies, attending physician(s), payors, other healthcare team members, etc.
Must demonstrate the ability to prioritize workload and manage time efficiently.
Computer skills in Microsoft Word, GroupWise, Meditech, and other applications.

Nice To Haves

Licensed Clinical Social Worker Upon Hire or Licensed Social Worker Upon Hire.
Certification in specialty and/or case management field. Upon Hire.
Data analysis preferred.

Responsibilities

Identifies needs of individuals and takes action to address these needs in conjunction with appropriate staff member/disciplines in a timely manner.
Reports occurrences of physical or emotional abuse and/or neglect.
Coordinates appropriate cost-effective discharge planning, based on assessment of patient needs and input from multidisciplinary team.
Works with physicians, staff from other departments, third party payors, families, community resources, etc. to facilitate transition of the patient throughout the continuum at the appropriate level of care.
Uses advance knowledge of healthcare, community resources, and recovery principles of care to plan and implement new or revised services.
Assists with the development, revision, and coordination of the Plan of Care through daily rounds, collaboration with the multidisciplinary treatment team, and communication with physicians, nurses, and other healthcare team members to meet the patients’ needs effectively and efficiently.
Identifies system/organizational processes which may affect effective utilization of resources, timely scheduling of tests, appropriate level of care being given, etc., and collaborates with team members to improve upon the processes.
Applies and effectively utilizes problem-solving techniques and conflict resolution to coordinate patient care.
Serves as a resource contact and information source to patients, families, significant others, and staff.
Maintains knowledge and satisfactorily complies with regulatory and third-party payors’ procedures, notification requirements and criteria, documentation required in the medical record, etc.
Minimizes financial loss to the organization through proactive identification and investigation of issues related to precertification, reimbursement, denials, insurance availability, etc., and promptly notifies physician.
Thoroughly and accurately documents actions/communication surrounding discharge planning and/or utilization management in the medical record.
Incorporates recovery principals into providing patient care.
Effectively organizes and provides leadership in treatment team meetings.
Effectively conducts patient and family counseling sessions and education.
Effectively facilitates therapeutic group treatment modalities (counseling, discharge planning, family support and education, etc.).
Provides brief individual, family, couple, and 1:1 counseling.
Communicates findings and pertinent information related to the patients’ hospitalization, length of stay, discharge planning, documentation requirements, insurance and reimbursement status to the appropriate department and/or staff.
Accurately documents pertinent information in the UR module.
Demonstrates understanding and effective implementation of role in maintain therapeutic and safe milieu.
Conducts and documents social history and psychosocial assessments accurately and within required time frame.
Describes Level of Care Policy, including responsibility and hand off process for minimum promise of every 15-minute safety checks.
Incorporates Continuous Comprehensive Integrated System of Care (CCISC) principles into providing patient care.
Ensures timely and comprehensive completion of admission, continued stay, and discharge reviews, using medical care review criteria.
Provides third party payors with status reports and enters information and results in the UR module within required time frames.
Completes variances and/or denials report and UR Module functionality in a timely manner.
Obtains information that is provided to third party payors, or if criteria is not met, to the physician.
Facilitates physician conference calls to address reimbursement and quality of medical care reviews.
Achieves, maintains, and demonstrates Non-Violent Crisis Intervention Skills (CPI certification).
Effectively represents BHU on the hospital Utilization Management Committee.
Assess patients for eligibility and clinical needs for post-acute inpatient services:
Completes the Inpatient Rehabilitation Facility Pre-Admission Screen.
Consults with the Rehabilitation Physician for final Inpatient Rehabilitation Facility admission determination including third party payor authorization.
Works with physicians, patient and significant others, the healthcare team (including finance department), third party payors, etc. to facilitate transition of the patient throughout the Inpatient Rehabilitation admission and post discharge plan of care.
Responsible for coordination and facilitation of Patient and Family Conferences, Team Conferences, Huddle, and family teaching.
Responsible for re-authorization by third party payors for patient continuing stay on Inpatient Rehabilitation.
Completes Medicaid late pick up calls.
Acts as liaison to outside facilities for patient admission.
Responsible for completing Medicare rights process.
Assists with the Discharge Planning Department's Care Coordination functions as needed.
Demonstrates service excellence and patient and family centered care by showing respect, honesty, fairness, and a positive attitude toward all customers.
Maintains confidentiality.
Demonstrates dependability, to include attendance and punctuality.
Is accountable - takes initiative and ownership of issues.
Displays a professional demeanor.
Represents hospital in a positive way.
Has a compassionate working relationship with patients and families.
Assumes personal responsibility for 2-way communication.
Communicates and listens effectively with patients, families, coworkers, other departments, physicians/providers and community.
Supports coworkers, initiatives and a patient and family centered philosophy; pitches in; does own part and helps others.
Works to continuously improve work environment/processes (Performance Improvement).
Demonstrates a patient and family centered focus when considering/developing improvement solutions.
Represents willingness/enthusiasm to create, embrace and facilitate change.
Develops self and others; supports a learning environment; leads by example.
Encourages patients and families to give feedback and suggestions for improvement.
Develops working relationships critical to the organization including patients, families, coworkers, other departments, physicians/providers and community.
Encourages others by providing recognition and support.