Case Manager / PRN - Social Worker

About the role

Select Specialty Hospital is seeking a Case Manager (PRN) with a Licensed Social Worker background. The position requires previous discharge planning experience, preferably in an inpatient hospital setting focusing on critical care/acute care patients.

Responsibilities

• Develops and implements a patient-specific, safe, and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Buils relationships and coordinates with payor sources to ensure proper reimbursement for hospital-provided services, promoting cost-effective care through focus on resource management within the plan of care.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Collaborates with Quality Management to ensure fulfillment of all licensure and accrediting requirements.
• Maintains fiscal responsibilities, ensuring the department identifies and negotiates the fullest possible reimbursement to maximize insurance benefit coverage for the patient.
• Reviews insurance verification forms to minimize risk.
• Facilitates multi-disciplinary team meetings involving physicians, nurses, respiratory therapists, and rehabilitation therapists.

Requirements

• Current licensure in Social Work per state guidelines.
• Previous SW experience in an inpatient hospital setting dealing with critical care/acute care patients (e.g., ICU, step-down, med surg, vents).
• Adequate experience in an acute medical case management setting and confidence to manage and direct a plan of care for chronically critically ill populations.

Preferred Qualifications

• Specific experience in Care Management and Discharge Planning.
• Working knowledge of the insurance industry and government reimbursement.
• Availability to work a minimum of 2 shifts per month on an "as needed" basis, typically from approximately 8a.m.-5p.m., on weekdays.