Social Work Care Mgr II IP

Emory Healthcare • Atlanta, GA

1h • Onsite

About The Position

The Social Work Case Manager II (SW CM) is responsible for patient care coordination from admission through discharge, ensuring smooth transitions of care as the patient is discharged from the hospital setting. This role 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, and identifies and addresses potential barriers to care coordination/discharge planning in an effort to foster efficient care delivery and maximize reimbursement. The SW CM begins the process of care coordination at the time of the patient's admission by completing a thorough admission assessment and/or psychosocial assessment, which allows for a timely and accurate capture of information and fosters the ability to begin working towards a discharge plan. The SW CM is an integral part of the interdisciplinary care team and is required to attend rounds, care conferences, and/or care team meetings. The SW CM acts as a representative of both the hospital care team and the patient/family to balance patient/family choice and projected care coordination needs with the ability to execute such services. The SW CM works with the hospital care team and the patient/family to plan and implement the best possible plan for the patient, considering various factors, limitations, and patient/family preference. The SW CM identifies and recommends post-acute services and completes referrals to appropriate post-acute care providers in a timely manner, coordinating directly with the patient/family and the care team. Through continuous assessment and review, the SW CM applies critical thinking to ensure alignment and appropriateness of post-acute services as the patient clinically progresses throughout their stay. Ultimately, the SW CM is responsible for ensuring the discharge plan is aligned to be executed with the patient's medically cleared for discharge date and the projected length of stay as provided by the payor. The SW CM identifies and participates in the development of strategies to reduce unnecessary length of stay and/or resource consumption. The SW CM escalates cases, as appropriate, to management, Physician Advisor, Complex Care team and/or Ethics committee. The role of the SW CM is to educate patients/families and the care team regarding post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources. The SW CM provides supportive and therapeutic communication for patients, families, and loved ones experiencing anxiety or stress due to illness, injury, or physical limitations. The SW RN responds 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 conveying an impression that reflects favorably upon the organization. In collaboration with Utilization Review, the SW CM initiates and facilitates discussions with payors to act as an advocate on behalf of the patient and hospital to reduce non-covered, non-authorized, or denied services. The SW CM serves as a resource to the Physician, Interdisciplinary Care Team, and patient for the interpretation of external regulations and organizational policies and procedures pertaining to Discharge Planning and Care Coordination. The SW CM ensures compliance with all regulatory requirements related to 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

• Masters in Social Work from an accredited Institution
• 2 years recent healthcare experience preferred
• Experience in Acute Care setting preferred
• LMSW license in the state of Georgia required
• Working knowledge of software/Eemr applications
• Must meet all quality and productivity expectations
• Successfully complete yearly competencies

Nice To Haves

• ACM, CCM preferred

Responsibilities

• Patient care coordination from admission through discharge
• Ensuring smooth transitions of care
• Procuring and securing post-acute services
• Coordinating and advocating for patients and families
• Identifying and addressing potential barriers to care coordination/discharge planning
• Completing thorough admission assessment and/or psychosocial assessment
• Attending rounds, care conferences, and/or care team meetings
• Balancing patient/family choice with projected care coordination needs
• Identifying and recommending post-acute services
• Completing referrals to appropriate post-acute care providers
• Applying critical thinking to ensure alignment and appropriateness of post-acute services
• Ensuring the discharge plan is aligned for execution
• Identifying and participating in strategies to reduce unnecessary length of stay and/or resource consumption
• Escalating cases as appropriate
• Educating patients/families and the care team
• Providing supportive and therapeutic communication
• Responding to suspected violent, assault, abuse and/or neglect cases
• Communicating confidently, effectively, and therapeutically
• Initiating and facilitating discussions with payors
• Serving as a resource for interpretation of external regulations and organizational policies
• Ensuring compliance with all regulatory requirements
• Ensuring proper use of Case Management Systems and workflows

Benefits

• Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
• Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level