Inpt Insurance Coord

Maimonides Medical Center•New York, NY

About The Position

The Inpt Insurance Coord partners with the psychiatry inpatient Social Worker or Social Worker Assistant to form the clinical case management team. The role develops, plans, organizes, implements, coordinates, monitors, and evaluates activities related to patient outcome management across the continuum of care, from preadmission through admission and post-discharge. The coordinator also serves as a liaison with nursing, medical staff, social work, psychiatric staff, and other clinical departments to integrate services into the patient care process. The position supports appropriate care and resource use, coordinates discharge planning, collaborates with managed care companies and community providers, and advises the care team, patients, and families on insurance benefits, utilization review, and care options. It participates in interdisciplinary planning and rounds, reviews records and admissions, identifies care or discharge barriers, and helps coordinate appropriate placements and timely discharges.

Requirements

LMSW required.
Minimum of 3 years of direct experience in utilization management, managed care liaison, discharge planning, case management, and inpatient psychiatry experience preferred.
Current clinical and technical social work skills.
Knowledge of child abuse and neglect reporting rules and regulations, as appropriate.
Familiarity with regulatory agency and third-party payor requirements.
Ability to use word processing, spreadsheet, and/or database programs as required by the position.
Excellent oral and written communication skills.
Good problem-solving, decision-making, and judgment skills.
Good interpersonal skills.
English speaking, reading, and writing proficiency to the extent required by the position.

Nice To Haves

LCSW preferred.
Experience in utilization management, managed care liaison, discharge planning, case management, and inpatient psychiatry preferred (minimum 3 years of direct experience stated).
Knowledge of a second language preferred.

Responsibilities

Provides age-appropriate care and intervention for patients served, including assessments, treatment plans, and assistance with assessments, or age-appropriate interpersonal support services for non-direct care providers.
Coordinates discharges requiring services from a certified home health agency.
Negotiates with vendors, providers, and mental health agencies to optimize services.
Collaborates with managed care companies to facilitate appropriate use of patient benefits and services, pursue optimum inpatient coverage, and arrange appropriate outpatient services or alternate agencies.
Serves as a clinical resource for the multidisciplinary health care team, patients, and families on insurance benefits, managed care processes, clinical and utilization review issues, and quality and length-of-care management.
Applies third-party payor procedures concerning financial coverage, non-coverage, and alternate levels of care; explains and distributes notifications to patients or family representatives.
Assists in completing discharges in a timely manner.
Reviews admissions within 24–48 hours to assess appropriateness for acute care and identify potential treatment or discharge problems; consults the responsible physician to clarify the plan of care when an admission appears inappropriate.
Acts as a liaison with social work, nursing, psychiatric staff, and other clinical departments to integrate services into the patient care process.
Consults and collaborates with physicians and other health care team members to coordinate care plans, determine cost-effective use of hospital resources, and remove obstacles to timely, efficient discharge.
Collects and analyzes patient data to advise the health care team on appropriateness of care, patient outcomes, and other continuum-of-care issues.
Facilitates multidisciplinary care plans for identified patient populations and participates in interdisciplinary rounds.
Identifies potential alternate-level-of-care patients, consults with the admitting physician about acute care needs and alternate plans, and collaborates with the care team on placement and required documentation.
Maintains a leadership role on the health care team to support high-quality care; identifies educational needs and participates in developing and implementing programs; coordinates multidisciplinary rounds, referrals, and case conferences.
Performs chart reviews covering length of stay, resource management, managed care contract compliance, patient outcomes, test and treatment sequencing and scheduling, consultations, care variations, and algorithm implementation; reports variations to the physician advisor, clinical chairman, or appropriate discipline.
Provides timely, professional, caring, and respectful customer service, demonstrating flexibility, knowledge, confidence, professionalism, a pleasant attitude, patience, and helpfulness.
Maintains departmental policies and procedures, objectives, quality assurance programs, and safety, environmental, and infection control standards.