Care Manager / Weekend Option

Emory•Decatur, GA

11d•Onsite

About The Position

The Social Work Care Manager I Weekend Option (SW CM I) coordinates patient care from admission through discharge, supporting smooth transitions from the hospital and high-quality clinical and cost outcomes. The role secures post-acute services, coordinates and advocates for patients and families with internal and external stakeholders, and identifies barriers to care coordination and discharge planning to support efficient care delivery and maximize reimbursement. The Care Manager begins coordination at admission by completing an admission and/or psychosocial assessment and initiating a discharge plan. As an integral member of the interdisciplinary care team, the role attends rounds, care conferences, and care team meetings. The Care Manager collaborates with the hospital team and patients and families to develop and implement an appropriate plan, balancing preferences and projected care needs with the ability to arrange services. This includes timely post-acute referrals and ongoing assessment of whether services remain appropriate as the patient’s condition changes. The discharge plan must align with the medically cleared discharge date and the payer’s projected length of stay. The position identifies and participates in strategies to reduce unnecessary length of stay and resource use, and escalates cases when appropriate to management, the Physician Advisor, Complex Care team, and/or Ethics committee. The Care Manager educates patients, families, and care teams about post-acute services, transitions, readmission mitigation, appropriate levels of care, and available resources. The role also provides supportive and therapeutic communication to people experiencing stress related to illness, injury, or physical limitations, and responds to suspected violence, assault, abuse, or neglect in accordance with social work ethics. In collaboration with Utilization Review, the Care Manager facilitates discussions with payors and advocates for patients and the hospital regarding non-covered, unauthorized, or denied services. The role serves as a resource on external regulations and organizational policies and procedures related to discharge planning and care coordination, ensures compliance with government and commercial payors and other applicable regulatory requirements, and uses case management systems and workflows appropriately.

Requirements

Master of Social Work degree from an accredited institution.
Working knowledge of software and electronic medical record (EMR) applications.
Must meet quality and productivity expectations and successfully complete yearly competencies.
Ability to meet the listed physical requirements, including occasional to frequent standing and walking, occasional sitting, close eye work, and lifting or carrying objects up to 25 pounds.

Nice To Haves

One year of recent healthcare experience preferred; acute care experience preferred.
ACM or CCM certification preferred.

Responsibilities

Coordinate patient care from admission through discharge and facilitate transitions from the hospital.
Complete admission and/or psychosocial assessments and begin discharge planning in a timely manner.
Attend rounds, care conferences, and care team meetings as part of the interdisciplinary care team.
Collaborate with patients, families, and the hospital care team to develop and implement appropriate care and discharge plans.
Identify post-acute services and make timely referrals to appropriate providers.
Continuously assess and review whether post-acute services remain appropriate as the patient’s clinical condition progresses.
Align discharge plans with the medically cleared discharge date and the payer’s projected length of stay.
Identify and participate in strategies to reduce unnecessary length of stay and resource consumption.
Escalate cases as appropriate to management, the Physician Advisor, Complex Care team, and/or Ethics committee.
Educate patients, families, and care teams about post-acute services, transitions of care, readmission mitigation, levels of care, and available resources.
Provide supportive and therapeutic communication to patients, families, and loved ones experiencing stress related to illness, injury, or physical limitations.
Respond to suspected violent, assault, abuse, and/or neglect cases in accordance with social work professional ethics.
Collaborate with Utilization Review to facilitate payor discussions and advocate regarding non-covered, unauthorized, or denied services.
Serve as a resource on external regulations and organizational policies and procedures related to discharge planning and care coordination.
Ensure compliance with government and commercial payors, third-party payers, and federal and state regulatory agencies.
Use case management systems and workflows properly.
Meet quality and productivity expectations and successfully complete yearly competencies.