Social Worker Care Manager

UnitedHealth Group • Portland, ME

237d • $49,300 - $96,400 • Onsite

About The Position

The Social Worker Care Manager (Discharge Planning) as part of a multidisciplinary team, including the patient / family, physicians, nurse's therapists, and payors ensures the patient's progress in the acute episode of care through post discharge and is quality driven while being efficient and cost effective. The incumbent interacts with patients, family members, healthcare professionals, and community and state agencies in this effort. The Care Manager / Social Worker serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The Social Worker (Discharge Planning) reviews high risk adult patients from a psychosocial and medical perspective and assesses the psychological needs of patients and families and provides information, support, counseling, care management, and referrals to appropriate resources. The Social Worker Care Manager and RN Care Manager work collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum. The expertise of the MSW is sought to resolve psychosocial patient care issues and to develop complex patient transition / discharge plan as needed. Will work in an acute care hospital setting, supporting patients and caregivers in the emergency department, critical care, and inpatient setting. The Social Worker Care Manager is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series provides case review to third party payers and assisting in the denial and appeals process as well as assessing quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent may have access to highly confidential patient, employee and / or Northern Light proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. This position is full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 175 Fore River Pkwy Portland, ME 04102. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Requirements

• Bachelor's Degree
• Active licensed Social Worker in the State of Maine
• Must be 18 years of age OR older
• 1+ years of Social Work experience
• Ability to work onsite at 175 Fore River Pkwy Portland, ME 04102
• Ability to work Monday - Friday, 08:00AM - 05:00PM with flexibility to work weekend shifts per business need
• Full Flu vaccination are an essential job function of this role.

Nice To Haves

• Master's Degree in Social Work (MSW)
• 6+ months of clinical experience as a Social Worker in an extended care facility, community healthcare, OR acute care setting
• Proficient experience with Microsoft Office (Microsoft Excel, Microsoft Word, Microsoft Teams, Microsoft Outlook)
• Experience with Cerner

Responsibilities

• Interacts with patients, family members, healthcare professionals, community and state agencies for adults in a hospital setting.
• Serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information.
• Reviews high risk patients from a psychosocial and medical perspective and assesses the psychological needs of patients and families and provides information, support, care management, and referrals to appropriate resources.
• The Social Worker and RN Care Manager work collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum.
• Performs duties and tasks in accordance with performance standards established for the job.
• May have access to highly confidential patient, employee and / or Northern Light organizations proprietary information and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards.
• Responsible for reporting all security events, potential events, or other security risks to the organization.
• Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care.
• Reviews patient charts.
• Provides assessment and social services to patients and their families in relation to social, psychological, financial, and family situations which will allow timely discharge facilitation.
• Obtains, interprets, and communicates necessary information regarding patients and families, including social history information, to staff and physicians.
• Attends Multi-Disciplinary Rounds, daily, per unit schedule.
• Meets with patients and families to provide psychosocial support as needed.
• Facilitates and coordinates details of placement and discharge to appropriate agencies.
• Discusses nursing, psychosocial needs and medical information with facilities.
• Provides and updates referrals to facilities through online / software discharge planning tools.
• Reviews and completes all appropriate information accompanying patient facility.
• Acts as a liaison between hospital and those facilities should discharged patients be hospitalized.
• Assists in arranging time and mode of transportation to facilities for patients.
• Facilitates and coordinates individualized discharge plan.
• Arranges and participates in care conferences with unit staff, home care staff, facility staff, patients and / or families.
• Provides adequate avenues of communication through on-going documentation in Cerner systems and telephone/verbal reporting or electronic tools.
• Coordinates and communicates with home care agencies regarding expected standards of care for requested specific treatments and psychosocial needs.
• Assists patients and families with obtaining community assistance by referral to proper resources.
• Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
• Develops and maintains good working relationships with outside community health and social agencies. Reaches out to the community to develop new resources for meeting patient needs.
• Discusses specific continuing care needs with physicians and hospital personnel on a regular basis.
• Completes appropriate State of Maine forms.
• Monitors the completion of the MEDEXX by Maximus for all first time Medicaid transfers to nursing facilities.
• Alerts Maximus to complete MEDEXX on Medicaid patients with expired bed holds.
• Alerts Maximus to complete MEDEXX on Medicaid patients with need for community programs.
• Documents in appropriate electronic system by the close of business each day.
• Consults with leadership as necessary to resolve barriers through appropriate administrative and medical channels.

Benefits

• $10,000 Sign-On Bonus for External Candidates
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree