Care Coordinator Social Worker

Job Details

Utilizes MSW education and experience to perform telephonic and onsite assessments of medically complex pediatric recipients in the PDN coordinate the care program.

• Regularly meets with the multidisciplinary team and contributes to the development of a comprehensive plan of care based on the needs of the patient and family.
• Utilizes independent judgement to evaluate and modify the plan of care as needed.
• Communicates changes to the family, healthcare team, and other agencies involved.
• Collaborates with the family and healthcare team to arrange for identified home care needs.
• Consults on patient care issues in area(s) of expertise.
• Functions as a resource to the community in areas of expertise.
• Documents all patient care activities appropriately.
• Manages daily workload associated with quality review process, including facilitation of case assignments and follows up to ensure that all cases requiring additional assistance or coordination are completed within timelines required by contract.
• Maintains system for tracking all incoming and outgoing correspondence in accordance with timelines and requirements of contract.
• Reviews documentation and prepares outgoing correspondence and notifications to physicians and provider representatives in accordance with policy and contract requirements.
• Affords assistance with the coordination and facilitation of Physician Peer to Peer conferences as necessary.
• Reviews incoming referrals and peer determinations and directs questionable referrals and/or determinations to appropriate manager for follow up.
• Functions as an expert resource to external customers.
• Participates in ongoing development, implementation, and evaluation of effectiveness of the program process, and works with management staff to formulate recommendations for process modifications when indicated.
• Participates in internal initiatives, functioning as an expert resource for other staff.
• Participates in gathering information/data for CMS reporting.
• Assists in the initial and ongoing training of nurses and coordinators regarding the process and other issues relevant to coordination of care.
• Provides courteous and prompt service to all internal and external customers.
• Identifies opportunities and recommends methods to improve service, work processes and financial performance.

Qualifications

MSW education and experience in working with medically complex pediatric recipients.

Skills

• Telephonic and onsite assessments
• Collaboration with multidisciplinary teams
• Independent judgement in evaluating and modifying plans of care
• Communication with families, healthcare teams, and other agencies
• Arranging for home care needs
• Consulting on patient care issues
• Resource to the community
• Documentation of patient care activities
• Quality review process management
• System for tracking correspondence
• Outgoing correspondence preparation
• Reviewing and preparing notifications
• Coordination and facilitation of Physician Peer to Peer conferences
• Reviewing and directing referrals and determinations
• Expert resource to external customers
• Ongoing development, implementation, and evaluation of program process
• Internal initiatives participation
• Gathering information/data for CMS reporting
• Training of nurses and coordinators
• Providing courteous and prompt service
• Service improvement recommendations