Care Manager Social Worker PRN

Advocate Health and Hospitals Corporation•Macon, GA

13d•Onsite

About The Position

The Care Manager Social Worker is responsible for participating in patient care unit rounds with the attending physician and healthcare team to coordinate communication and ensure consistency in patient discharge planning. This role involves assessing patients' discharge and post-acute transition needs, developing discharge plans that address physical, functional, social, and psychological status, as well as cultural, language, caregiver, and benefit needs. The Care Manager assigns appropriate care pathways, ensures coordination of services among physicians, specialists, community agencies, and vendors, and utilizes clinical judgment, evidence-based guidelines, and patient preferences in decision-making. They also prepare and maintain documentation, close cases in a timely manner, and refer cases for post-discharge follow-up. Additionally, this role involves advocating for patients' best interests regarding funding, treatment, and care coordination, integrating patient-centered care, and communicating the plan of care to patients and families. The Care Manager also performs Utilization Management duties, acting as a liaison between the Precert Team and physicians, ensuring CMS compliance, issuing IMM notices, monitoring CarePathways, making referrals to UM Physician Advisors, and collaborating with physicians to address service delays.

Requirements

Minimum of three years of recent experience in acute care, home health, case management, discharge planning or care management.
Must be able to use visual acuity to see monitor screen, computer and hard copy materials.
Must be able to hear and verbally communicate in person and over the phone or radio.
Must be able to sit for prolonged periods of time (up to 2 hours).
Must be able to comprehend and learn operation of various office equipment.
Must have functional range of motion of the cervical, thoracic and lumbar spines, upper and lower extremities with a grip strength of 50-60# specific to job evaluation.
Must be able to forward reach, overhead reach, bend, squat, kneel and apply proper body mechanics during the transfers and transport supplies and/or equipment using proper body mechanics.
Must be able to lift up to 10# specific to job evaluation.

Nice To Haves

Certification in Care/Case Management preferred.
Master’s degree preferred.
Experience as a Care Manager preferred.
Experience with IT solutions such as electronic health record, learning management or disease/care management systems a plus.

Responsibilities

Participates in rounds on the patient care unit with the attending physician and other members of the health care team; coordinates communication to assure collaboration and consistency in moving the patient’s care to estimated date of discharge.
Assesses patients to determine their discharge planning and/or post-acute transition needs.
Develops the discharge plan and works with the physician to implement the plan utilizing internal and external resources to ensure a safe discharge or transition to alternate level of care.
Assigns the appropriate care pathway based on the clinical feedback from the physician and the diagnosis-DRG.
Ensures coordination of services among the patient's physicians, specialists, community agencies and vendors.
Works collaboratively with patient's physicians and members of the multidisciplinary team to assure communication and exchange of input related to patient's specific care needs.
Utilizes clinical judgment, independent analysis, evidence-based clinical guidelines, patient preference, and input from interdisciplinary team in making decisions.
Assesses progress toward goals and identifies barriers to meeting goals.
Prepares and maintains appropriate documentation of patient care and progress within the designated systems.
Closes cases in accordance with defined case closure procedure in a timely manner and in accordance with established guidelines.
Refers cases for post discharge follow up to the Care Navigator-Outpatient.
Advocate in the patient's best interest for necessary funding, treatment alternatives, timelines and coordination of care, with frequent evaluations of progress and goals.
Continues to identify community and caregiver resources to ensure continuity of care during and after completion of the care management plan.
Integrates patient-centered care into the nursing processes to include the patient(s) and family in care decisions, incorporating evidence based practices to achieve safe and effective patient and process outcomes.
Communicates plan of care to patient and family and solicits concerns, questions, and issues for resolution.
Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals.
Performs Utilization Management duties as indicated by the UM Plan and the payer requirements.
Acts as a liaison between the Precert Team and the physician.
Performs all duties related to utilization review as mandated by Navicent Health UM plan and by regulatory agencies such as DNV, CMS, Payers, DCH, etc.
Works with Physician to establish the appropriate admission status for billing.
Ensures all aspects of the process are addressed from a CMS compliance standpoint.
Issues the IMM notice to discharging patient, Monitors CarePathways entering clinical information into the system and using an established UR criterion.
Makes referrals to the UM Physician Advisors as per policy.
Works with Attending Physician to ensure changes to status are supported by order and documentation.
Track utilization of professional services, service delays, discharge delays, etc and reports as necessary.
Provides collaboration with the Attending Physician to work through the delays.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program