Social Work Care Manager

About the role

Coordinates patient care from admission through discharge, ensuring smooth transitions and facilitating high-quality clinical outcomes. Acts as an advocate for patients and families while collaborating with the interdisciplinary team to implement effective discharge plans.

Responsibilities

• Complete thorough admission and/or psychosocial assessments at time of patient admission to support timely and accurate discharge planning.
• Attend rounds, care conferences, and/or care team meetings as an integral member of the interdisciplinary care team.
• Balance patient/family choice and projected care coordination needs with the ability to execute services.
• Plan and implement the best possible care plan in collaboration with the hospital care team and patient/family, considering clinical factors, limitations, and preferences.
• Identify, recommend, and complete timely referrals to appropriate post-acute care providers; coordinate directly with patient/family and care team.
• Apply critical thinking to ensure alignment and appropriateness of post-acute services as the patient clinically progresses.
• Ensure discharge plan aligns with medically cleared discharge date and payor-provided projected length of stay.
• Develop and participate in strategies to reduce unnecessary length of stay and/or resource consumption.
• Escalate cases to management, Physician Advisor, Complex Care team, and/or Ethics committee as appropriate.
• Educate patients/families and care teams on post-acute services, transitions of care, readmission mitigation, appropriate post-acute level of care choices, and available resources.
• Provide supportive and therapeutic communication to patients, families, and loved ones experiencing anxiety or stress due to illness, injury, or physical limitations.
• Communicate confidently, effectively, and therapeutically while being assertive and conveying a favorable impression of the organization.
• Initiate and facilitate discussions with payors to advocate on behalf of the patient and hospital, reducing non-covered, non-authorized, or denied services.
• Issue and administer notices of non-coverage and potential liability to patients in accordance with regulations, policies, and procedures.
• Serve as a resource to physicians, interdisciplinary care teams, and patients for interpretation of external regulations and organizational policies related to discharge planning and care coordination.
• Ensure compliance with all regulatory requirements related to government and commercial payors, third-party payers, and federal and state regulatory agencies.
• Ensure proper use of case management systems and workflows.

Requirements

RN CM:

• Valid, unencumbered Registered Nurse License approved by the Georgia Board of Nursing.
• Two (2) years experience in healthcare.

Preferred:

• Bachelor’s degree in Nursing from an accredited school of nursing.

SW CM I:

• Master’s in Social Work from an accredited school of social work.
• Demonstrated knowledge of software/EMR applications.

Preferred:

• One (1) year healthcare experience in an acute care setting.
• Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.

SW CM II:

• Master’s in Social Work from an accredited school of social work.
• Licensed as a Master Social Worker (LMSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage & Family Therapists.
• Demonstrated knowledge of software/EMR applications.

Preferred:

• Two (2) years healthcare experience in an acute care setting.
• Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.

SW CM III:

• Master’s in Social Work from an accredited school of social work.
• Licensed as a Clinical Social Worker (LCSW) through the Georgia Composite Board of Professional Counselors, Social Workers, and Marriage & Family Therapists.
• Demonstrated knowledge of software/EMR applications.

Preferred:

• Three (3) years healthcare experience in an acute care setting.
• Accredited Case Manager (ACM) Certification through the American Case Management Association or Certified Case Management (CCM) through the Commission for Case Manager Certification.

Skills

• Critical thinking
• Conflict resolution
• Care coordination
• Regulatory compliance
• Discharge planning
• Patient advocacy
• Interdisciplinary collaboration
• Referral management
• Resource utilization
• Therapeutic communication
• Psychosocial assessment
• Clinical documentation
• Case management systems
• EMR applications

Benefits

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship and leadership programs