Clinical Social Worker

About the role

HSS is an innovative, supportive, and inclusive environment dedicated to transforming healthcare through exceptional talent. We seek candidates who align with our mission and are passionate about maximizing growth and success.

Responsibilities

• M - F 8 AM - 4 PM 2 Weekends per Quarter OR as needed
• Sitting in a comfortable position with frequent opportunity to move about the department and traverse the hospital campus
• Develops/Manages Processes & Systems - Assists with contracts
• Assists in the negotiation of physician managed care contracts, analytics, and financial modeling
• Upholds Standards/Expectations of HSS Staff - Coordinates enrollment
• Carefully coordinates physician enrollment in managed care plans
• Upholds Standards/Expectations of HSS Staff - Ensures compliance
• Ensures compliance of managed care companies with negotiated contracts
• Upholds Standards/Expectations of HSS Staff - Resolves payor issues
• Follows-up and resolves payment issues with Insurance Payors
• Upholds Standards/Expectations of HSS Staff - Acts as liaison
• Acts as a liaison between physician offices and Insurance Payors
• Upholds Standards/Expectations of HSS Staff - Assists with meetings
• Schedules, coordinates, and documents for all PHO related meetings
• Maintains Documentation & Manages Information - Maintains tracking logs
• Creates and maintains tracking logs for Insurance Payor issues and accountability for closing out items
• Upholds Standards/Expectations of HSS Staff - Oversees PHO line
• Oversees PHO phone line, answers and responds to inquires, and assists with urgent physician office issues
• Upholds Standards/Expectations of HSS Staff - Attendance
• Maintains satisfactory attendance record
• Upholds Standards/Expectations of HSS Staff - Maintains punctuality
• Reports for duty punctually
• Upholds Standards/Expectations of HSS Staff - Adjusts to change
• Adjusts to changing situations and work assignments

Requirements

• Two years experience in case management with discharge planning or equivalent in acute or home care clinical setting
• Orthopedic nursing
• Knowledge of regulatory agency standards
• Strong problem solving skills
• Ability to manage multiple tasks and projects independently
• Ability to assess clinical and discharge needs of orthopedic surgical patients
• Knowledge of Milliman (MCG) criteria
• PRI/screen certification

Qualifications

• Masters in Social Work
• LCSW Certifications/Licensure

Skills

• Ability to assess clinical and discharge needs of orthopedic surgical patients
• Knowledge of Milliman (MCG) criteria
• PRI/screen certification

Benefits

The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation.

Pay

The base pay scale for this position is $118,311.47 - $134,311.47.

Schedule

M - F 8 AM - 4 PM 2 Weekends per Quarter OR as needed