Care Management Specialist - Behavioral Health - Day

About the role

Provides assessment and coordination of care for patients from admission through discharge by maximizing available internal and external resources to reduce length of stay and improve quality of care.

This includes assessing, planning, implementing, coordinating, and evaluating health and community related services to meet patient/family physical, psychosocial, vocational and health needs in a cost effective, outcomes oriented and timely manner.

Responsibilities

• Identifies needs of individuals and takes action to address these needs in conjunction with appropriate staff member/disciplines in a timely manner.
• Reports occurrences of physical or emotional abuse and/or neglect.
• Captures and coordinates appropriate cost-effective discharge planning, based on assessment of patient needs and input from multidisciplinary team.
• Works with physicians, staff from other departments, third party payors, families, community resources, etc. to facilitate transition of the patient throughout the continuum at the appropriate level of care.
• Uses advance knowledge of healthcare, community resources, and recovery principles of care to plan and implement new or revised services.
• Aids in the development, revision, and coordination of the Plan of Care through daily rounds, collaboration with the multidisciplinary treatment team, and communication with physicians, nurses, and other healthcare team members to meet the patients’ needs effectively and efficiently.
• Identifies system/organizational processes which may affect effective utilization of resources, timely scheduling of tests, appropriate level of care being given, etc., and collaborates with team members to improve upon the processes.
• Applies and effectively utilizes problem-solving techniques and conflict resolution to coordinate patient care.
• Serves as a resource contact and information source to patients, families, significant others, and staff.
• Maintains knowledge and satisfactorily complies with regulatory and third-party payors’ procedures, notification requirements and criteria, documentation required in the medical record, etc.
• Minimizes financial loss to the organization through proactive identification and investigation of issues related to precertification, reimbursement, denials, insurance availability, etc., and promptly notifies physician.
• Thoroughly and accurately documents actions/communication surrounding discharge planning and/or utilization management in the medical record.
• (BHU Only) Incorporates recovery principals into providing patient care.
• (BHU Only) Effectively organizes and provides leadership in treatment team meetings.
• (BHU Only) Effectively conducts patient and family counseling sessions and education.
• (BHU Only) Effectively facilitates therapeutic group treatment modalities (counseling, discharge planning, family support and education, etc.).
• (BHU Only) Provides brief individual, family, couple, and 1:1 counseling.
• (BHU Only) Communicates findings and pertinent information related to the patients’ hospitalization, length of stay, discharge planning, documentation requirements, insurance and reimbursement status to the appropriate department and/or staff. Accurately documents pertinent information in the UR module.
• (BHU Only) Demonstrates understanding and effective implementation of role in maintain therapeutic and safe milieu.
• (BHU Only) Conducts and documents social history and psychosocial assessments accurately and within required time frame.
• (BHU Only) Describes Level of Care Policy, including responsibility and hand off process for minimum promise of every 15-minute safety checks.
• (BHU Only) Incorporates Continuous Comprehensive Integrated System of Care (CCISC) principles into providing patient care.
• (BHU Only) Ensures timely and comprehensive completion of admission, continued stay, and discharge reviews, using medical care review criteria. Provides third party payors with status reports and enters information and results in the UR module within required time frames.
• (BHU Only) Completes variances and/or denials report and UR Module functionality in a timely manner.
• (BHU Only) Obtains information that is provided to third party payors, or if criteria is not met, to the physician. Facilitates physician conference calls to address reimbursement and quality of medical care reviews.
• (BHU Only) Achieves, maintains, and demonstrates Non-Violent Crisis Intervention Skills (CPI certification).
• (Inpatient Rehab only) Assess patients for eligibility and clinical needs for post-acute inpatient services: Completes the Inpatient Rehabilitation Facility Pre-Admission Screen.
• (Inpatient Rehab only) Works with physicians, patient and significant others, the healthcare team (including finance department), third party payors, etc. to facilitate transition of the patient throughout the Inpatient Rehabilitation admission and post discharge plan of care.
• (Inpatient Rehab only) Responsible for coordination and facilitation of Patient and Family Conferences, Team Conferences, Huddle, and family teaching.
• (Inpatient Rehab only) Responsible for re-authorization by third party payors for patient continuing stay on Inpatient Rehabilitation.
• (Inpatient Rehab only) Completes Medicaid late pick up calls.
• (Inpatient Rehab only) Acts as liaison to outside facilities for patient admission.
• (Inpatient Rehab only) Responsible for completing Medicare rights process.
• (Inpatient Rehab only) Assists with the Discharge Planning Department's Care Coordination functions as needed.

Qualifications

• Minimum Education: Bachelors Degree in Social Work but Inpatient Behavioral Health may have Bachelor’s degree in Psychology and Inpatient Rehabilitation may have bachelor's degree in human services.
• Required Masters Degree in social work (or Psychology for inpatient behavioral health).
• Required 2 years Relevant experience.
• Required Data analysis.
• Preferred 2 years Experience in a behavioral health setting for a Behavioral Health Unit.
• Preferred Licensed Clinical Social Worker Upon Hire.
• Preferred Licensed Social Worker Upon Hire.
• Preferred Certification in specialty and/or case management field. Upon Hire.

Skills

Excellent clinical knowledge and be able to perform assessments and evaluate services, and display excellent interpersonal and leadership competence in order to interact effectively with the patient, the patient’s family, community service providers/agencies, attending physician(s), payors, other healthcare team members, etc.

Demonstrated ability to prioritize workload and manage time efficiently.

Computer skills in Microsoft Word, GroupWise, Meditech, and other applications.

Benefits

Comprehensive health benefits
Retirement savings plan
Paid time off (PTO)
Education assistance
Financial education and support, including DailyPay
Expanded Paid Parental Leave

Pay

TBD

Schedule

Full Time, Day Shift (80 hours biweekly)

Hours

Monday - Friday, 7:30am - 4:00pm

Rotation

Weekend rotation

About the Team

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.

About Us

WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.