Case Management Social Worker PD

Employment Type

: Full-Time


: Miscellaneous

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**Description:** **BASIC FUNCTION:** The Case Manager Social Worker in partnership with physicians, nursing and healthcare team members, utilizes professional medical social work skills to assess patient and family needs for complex discharge planning, complex placements, information and referral, psych-social and counseling support needs, and establishes plans for effective management of the identified needs. Assessment, planning intervening and re-assessment are performed in a collaborative environment. The Case Manager Social Worker's role also includes proactive, individualized planning for patients' progress across the continuum that optimizes quality of care, patient satisfaction, utilization and cost. **SUPERVISORY ACCOUNTABILITY:** None **NATURE AND SCOPE:** This position will communicate and interact with patients, families, physicians, both at CCIRH and external as well as outside agencies, payers, CCIRH nursing and other staff as well as management. **PRINCIPAL ACCOUNTABILITIES:** Supports the mission, vision and values of the hospital. Responsible for working in a safe and protective manner at all times, keeping in mind that safety and environmental hazards are the responsibility of all employees for themselves, other staff members and patients. Collaborates with the Case Manager RN to identify patients with complex social or supportive needs, including but not limited to: psychiatric diagnosis or behaviors, drug or alcohol abuse, homelessness, perinatal, neonate or obstetric-related issues, new diagnosis of cancer or other life-altering disease, or protective services situations. Identifies patient/family/significant other ability to participate in the plan and establishes strategies to overcome barriers identified. Accurately identifies high risk factors such as family dysfunction, impaired coping, financial, regulatory factors that might limit effective participation in planning and decision making. Performs psychosocial assessments that are consistently comprehensive and reflect early identification of complex problems or changes in condition that would necessitate revisions to the plan for psychosocial management or disposition. Assumes leadership role in managing catastrophic cases and establishes optimal plans that are executed in a timely manner. Collaborates with Case Manager RN and nursing staff to facilitate plan of care related to discharge planning. Communicates with patient's family and physicians and other team members to optimize plan for discharge/disposition. Assures seamless transitions for the patient/family across the continuum of care by establishing appropriate plans and assuring complete and accurate communication prior to transitions. Demonstrates knowledge of resources available in the system, community and utilizes effectively in supporting the patient during the episode of care and discharge preparations. Prioritizes cases effectively in order to achieve timely and appropriate patient disposition. Interfaces with Ethics Committee when ethical issues are recognized. Provides face to face encounters with patient and families and performs admission assessments and based on criteria and clinical knowledge monitors appropriateness of in-patient stay. Confers with physicians or physician advisor regarding the appropriateness of treatment plan. Intervenes as needed to prevent denial of coverage issues and identifies potential denials in a timely manner and communicates appropriately to the Case Manager RN, and leadership team. Provides clinical information to insurance companies to obtain authorizations and coordinates services with insurance companies to assist in transition planning. Monitors and applies federal and state regulations. Monitors and identifies administrative issues that may affect reimbursement or increased length of stay (facility delays, lack of documentation). Communicates findings to manager. Monitors the patient's progress towards meeting physical, emotional, educational needs to insure optimal outcomes. Coordinates services required for complex patients and advocates on the patient's behalf for scarce resources if gaps exists. Fosters cordial, positive and professional interpersonal relationships with patients, family members, insurance companies and peers. Negotiates with patients, nursing homes, insurance companies to provide efficient and successful patient transitions through the continuum. Documents psychosocial assessment in Midas including assessment and discharge plan, interventions, resources used by the end of the shift to assure a complete accurate medical record. Maintains adequate and timely progress notes in each patient's medical record by the end of the shift. Uses PC communication tools, reads email daily and responds to voice mails within 24 hours. Assists in educating patient/family about advance directives, when needed. Maintains current knowledge of The Joint Commission guidelines, CCIRH Utilization Review Plan and financial terms (i.e., PPO, HMO, expected length of stay and avoidable days). Possess working knowledge of discharge planning concepts, community resources, Medicare and Medicaid guidelines for acute care and skilled/intermediate nursing home care. Understands the difference between observation and in-patient status and the financial impact it has on the patient. Attends at least one hospital based class for professional growth. Seeks additional learning opportunities. Adheres to scheduling to include weekend rotation. Performs other duties as assigned. **CORE COMPETENCIES:** Excellent communication skills, both written and verbal. Must have excellent organizational and problem solving skills. Ability to interact well with others and be a team player. Demonstrates tact, diplomacy, negotiation skills and customer relations. Ability to work independently. Ability to prioritize assignments and effective time- management skills. Must be detail oriented, flexible and committed to patient advocacy. **MINIMUM REQUIREMENTS:** Master's prepared or Bachelor's Degree in social work or related field. Three to five (3-5) years of recent acute clinical experience or healthcare experience preferred. Prior case management experience preferred. Prior experience with neonatal, perinatal, obstetrics, oncology, psychiatric, substance abuse, and homeless populations preferred. Knowledge of diagnosis, expected treatment and discharge planning needs. Basic knowledge of clinical and psychosocial aspects of patient care. PC proficiency with MS Office products; experience with Midas software preferred. **CCIRH IS A DRUG AND NICOTINE FREE WORKPLACE** The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic's Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility. Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities </script>

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