Care Manager / Weekend Option

About the Role

The Social Work Care Manager I WEO (SW CM I) coordinates patient care from admission through discharge, ensuring smooth transitions and facilitating high-quality clinical and cost outcomes.

Key Responsibilities

• Procure and secure post-acute services.
• Coordinate and advocate for patients and families with internal and external stakeholders.
• Identify and address potential barriers to care coordination/discharge planning to foster efficient care delivery and maximize reimbursement.
• Begin care coordination at admission by completing a thorough admission assessment and/or psychosocial assessment.
• Attend rounds, care conferences, and/or care team meetings as part of the interdisciplinary care team.
• Act as a representative of both the hospital care team and the patient/family to balance patient/family choice with projected care coordination needs.
• Plan and implement the best possible patient plan, considering various factors, limitations, and patient/family preferences.
• Identify post-acute services and complete timely referrals to appropriate post-acute care providers, coordinating directly with the patient/family and the care team.
• Apply critical thinking through continuous assessment and review to ensure alignment and appropriateness of post-acute services as the patient progresses.
• Ensure the discharge plan aligns with the patient's medically cleared discharge date and projected length of stay as provided by the payor.
• Identify and participate in developing strategies to reduce unnecessary length of stay and/or resource consumption.
• Escalate cases to management, Physician Advisor, Complex Care team, and/or Ethics committee as appropriate.
• Educate patients/families and the care team on post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources.
• Provide supportive and therapeutic communication for patients, families, and loved ones experiencing anxiety or stress.
• Respond to suspected violent, assault, abuse, and/or neglect cases in accordance with social work professional ethics.
• Communicate confidently, effectively, and therapeutically, while being assertive and reflecting favorably upon the organization.
• In collaboration with Utilization Review, initiate and facilitate discussions with payors to advocate for the patient and hospital to reduce non-covered, non-authorized, or denied services.
• Serve as a resource to the Physician, Interdisciplinary Care Team, and patient for interpreting external regulations and organizational policies related to Discharge Planning and Care Coordination.
• Ensure compliance with all regulatory requirements for Government and Commercial Payors.
• Ensure compliance with all third-party payers and federal and state regulatory agencies.
• Ensure proper use of Case Management Systems and workflows.

Requirements & Tech Stack

• Working knowledge of software/Eemr applications.
• Case Management Systems.

Qualifications

• Masters in Social Work from an accredited Institution.
• 1 year recent healthcare experience preferred.
• Experience in Acute Care setting preferred.
• ACM, CCM preferred.
• Must meet all quality and productivity expectations.
• Must successfully complete yearly competencies.

Physical Requirements: Medium, up to 25 lbs max lifting/carrying.

Environmental Factors: May include blood-borne pathogen exposure, bio-hazardous waste, chemicals, communicable diseases, electrical shock, hot/cold temperatures, latex, radiation, shift work, and travel. Use of personal protective equipment, including respirators, may be required.