Social Work CM I IP, WEO

Emory Healthcare•Atlanta, GA

2d•Onsite

About The Position

The Social Work Care Manager I WEO (SW CM I) is responsible for patient care coordination from admission through discharge. This role ensures smooth transitions of care as the patient is discharged from the hospital setting, aiming for high-quality clinical and cost outcomes. The SW CM procures and secures post-acute services, coordinates and advocates for patients and families with internal and external stakeholders, and identifies and addresses potential barriers to care coordination/discharge planning to foster efficient care delivery and maximize reimbursement. The SW CM begins care coordination at admission by completing a thorough admission assessment and/or psychosocial assessment to capture information and initiate discharge planning. The SW CM is a key member of the interdisciplinary care team, participating in rounds, care conferences, and care team meetings. They act as a representative of the hospital care team and the patient/family, balancing patient/family choice and care coordination needs with service execution capabilities. The SW CM collaborates with the hospital care team and patient/family to plan and implement the best possible patient care plan, considering various factors, limitations, and preferences. They identify post-acute services and complete referrals to appropriate providers in a timely manner, coordinating with the patient/family and care team. Through continuous assessment, the SW CM uses critical thinking to ensure post-acute services align with patient clinical progression. The SW CM is responsible for ensuring the discharge plan aligns with the patient's medically cleared discharge date and the payor's projected length of stay. They identify and contribute to strategies for reducing unnecessary length of stay and resource consumption. The SW CM escalates cases to management, Physician Advisor, Complex Care team, and/or Ethics committee as appropriate. They educate patients/families and the care team on post-acute services, transitions of care, readmission mitigation, appropriate post-acute care levels, and available resources. The SW CM provides supportive and therapeutic communication to patients, families, and loved ones experiencing anxiety or stress due to illness, injury, or physical limitations. They respond 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 projecting a positive image of the organization. In collaboration with Utilization Review, the SW CM initiates and facilitates discussions with payors to advocate for the patient and hospital, aiming to reduce non-covered, non-authorized, or denied services. The SW CM serves as a resource to physicians, the Interdisciplinary Care Team, and patients for interpreting external regulations and organizational policies related to Discharge Planning and Care Coordination. They ensure compliance with all regulatory requirements for Government and Commercial Payors, third-party payers, and federal and state regulatory agencies. The SW CM ensures proper use of Case Management Systems and workflows.

Requirements

Must have a Masters in Social Work from an accredited Institution.
Must have working knowledge of software/Eemr applications.
Must meet all quality and productivity expectations and successfully complete yearly competencies.

Nice To Haves

1 year recent healthcare experience preferred
experience in Acute Care setting preferred
ACM, CCM preferred

Responsibilities

Responsible for patient care coordination from admission through discharge.
Ensures smooth transitions of care as the patient is discharged from the hospital setting.
Ensures and facilitates high quality clinical and cost outcomes.
Procures and secures post-acute services.
Coordinates and advocates for patients and families with both internal and external stakeholders.
Identifies and addresses potential barriers to care coordination/discharge planning.
Completes a thorough admission assessment and/or psychosocial assessment.
Attends rounds, care conferences, and/or care team meetings.
Acts as a representative of both the hospital care team and the patient/family.
Plans and implements the best possible plan for the patient.
Identifies post-acute services and completes referrals to appropriate post-acute care providers in a timely manner.
Applies critical thinking to ensure alignment and appropriateness of post acute services.
Ensures 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.
Identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption.
Escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee.
Educates 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.
Provides supportive and therapeutic communication for patients, families and loved ones who are experiencing anxiety or stress due to illness, injury or physical limitations.
Responds to suspected violent, assault, abuse and/or neglect cases in accordance with social work professional ethics.
Initiates and facilitates discussions with the payors to act as an advocate on behalf of the patient and hospital.
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.
Ensures compliance with all regulatory requirements as it relates to Government and Commercial Payors.
Ensures compliance with all third party payers and federal and state regulatory agencies.
Ensures proper use of Case Management Systems and workflows.