Social Work Care Manager Per Diem-28312

About the role

The Social Work Care Mgr (CM) works with physician practices and inpatient teams to promote the effective utilization of services and coordination of patient centered care. The CM contributes to the team's effectiveness by reviewing plans of care, identifying barriers to effective and efficient utilization of resources, and appraising patients' psychosocial, financial and clinical needs throughout the continuum of care. The CM functions as a liaison between patients, physician practices, the hospital, and the community and ensures that patients' continuity of care and psychosocial needs are met.

Responsibilities

• Functions as an expert clinical practitioner within the Case Management team and serves as a resource to assigned physician practice groups.
• Shares their professional expertise as a social worker and serves as a resource for CMs within their team to manage socially complex cases.
• Provides basic assessment of patients' health care needs, monitors patients' progress, and confers with physician practice group and health care team regarding variances from the anticipated plan of care.
• Sets up and coordinates social services to patients and their families.
• Assesses patient's basic and in-depth psychosocial, financial, cultural, and family situation.
• Manages a complex patient caseload and demonstrates expert ability to coordinate and implement discharge management services and provide continuity of care planning.
• Finds community resources for potential sources of assistance, maintains contact with community resources, and consults with physicians and inpatient groups regarding use of community resources.
• Reviews admissions and ongoing stays of patients with respect to the medical necessity, appropriateness, and quality of care.
• Applies criteria, performs concurrent review process.
• Works with physicians and Medical Director regarding Case issues and concurrent denials as indicated.
• Applies pathways/guidelines, assesses variances, and proposes interventions as indicated.
• Participates in the development, implementations and evaluation of pathways/guidelines and process improvement plans.
• Collaborates with inpatient staff and physician groups to determine goals for length of stay management and discharge management activities.
• Promotes cost-effective quality care services.
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