✓You’ll need
Licensure
Licensed Social Worker preferred
Certifications
✓With utilization review, obtains certification on admissions and continued certification by providing clinical information to the payer or to review companies designated by the resident's payer
Education
✓Bachelor's Degree in social work or a related discipline such as psychology or counseling as stated in DEHC Regulations 61-17.
BSN, MSW preferred
Qualifications
✓Excellence in communication skills to include written and verbal; thorough and detailed documentation experience.
✓Strong computer skills.
Experience in Social Services in a health care facility or healthcare field within the past five (5) years preferred
3-5 years' experience preferred
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About the role
- The Social Worker has knowledge and skill in the areas of discharge planning, transition of care, utilization management, medical necessity, and patient status determination. The Social Worker facilities effective processes based on the regulatory and reimbursement requirements of various commercial and governmental payers. The Social Worker assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human services needs. They provide cost-effective services while maintaining quality care through collaboration with health care providers to coordinate the transition of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. The Social Worker performing utilization management provides the critical function of obtaining certification and approval of the resident's hospital stay as required by the payer. Minimum Requirements Education
- Bachelor's Degree in social work or a related discipline such as psychology or counseling as stated in DEHC Regulations 61-17. Experience
- Experience in Social Services in a health care facility or healthcare field within the past five (5) years preferred
- Excellence in communication skills to include written and verbal; thorough and detailed documentation experience.
- Strong computer skills. License/Registration/Certifications N/A Preferred Requirements Preferred Education
- BSN, MSW Preferred Experience
- 3-5 years' experience Preferred License/Registration/Certifications
- Licensed Social Worker preferred
- RN Core
- Complies with established policies and procedures Complies with regulatory requirements of utilization review and discharge planning Responsible for assessment and reassessment of resident's physical, social, emotional, and financial needs Develop a comprehensive resident centered discharge plan, incorporating the resident goal into the discharge plan Communicates with the resident/family/care giver and interdisciplinary resident care team to facilitate resident care, development of comprehensive resident centered discharge plan and utilization review functions Negotiates timely decisions to expedite the discharge plan and ensure seamless transitions across the continuum of care Documents clearly and concisely all contacts and information of the resident's case management process in the medical record Performs initial and subsequent utilization reviews utilizing criteria With utilization review, obtains certification on admissions and continued certification by providing clinical information to the payer or to review companies designated by the resident's payer Monitors and secures final certification up to and after patient discharge until resolved Assists with management of incoming faced communication With utilization review, assists with initial denial, peer to peer information, status determination and/or appeal process and communicates necessary information to the physician advisor, and administrator Uses communication tools to ensure that information is collected, reviewed, escalated if needed and disseminated appropriately for all commercial, managed care and government plans Communicates updated insurance information to the centralized referral center in insurance information provided is not accurate Performs timely data entry of information when results are received including covered, denied and avoidable days Complied with delivery of regulatory notices, Important Message, Medicare Outpatient Observation Notice, Detailed Notice of Discharge and Hospital Issued Notices of Non-Coverage Plans effectively in order to meet resident's needs, manage length of stay and promote efficient utilization of resources Provides cost-effective services through resource management and facilitating throughput while maintaining quality care and meeting customer service needs by collaborating with healthcare providers to coordinate care delivery Provides resident/family/caregiver with quality data-based information on Post-Acute providers to facilitate referrals to meet the care transition needs of the resident Utilizes a secure electronic platform to communicate with Post-Acute providers and payers Completed required education and ongoing competencies as assigned Assists/Coordinates admissions with outside facilities and communicates to leadership team. Daily review of NaviHealth referral system Resolve roommate issues Facilitates replacement of resident items Coordinates family Care Conferences. Updates job knowledge by participating in educational opportunities, reading professional publications - maintaining personal networks; participating in professional organizations Other duties as assigned Relationship and Team Building :
- Treats everyone with dignity and respect; accepts the opinion of all other people; develops trusting relationships with employees
- Shares complete and accurate plans and goals appropriately to staff recognizing workplace success
- Recognizes and encourages the behaviors that contribute to teamwork (e.g. cooperation, sharing information and expertise, providing feedback, working together, putting team success first, etc.)
- Coaches and provides feedback to team based on observed behaviors that contribute or detract from effective relationships
- Fairly and consistently identifies areas of agreement and disagreement or inconsistency in order to identify issues or aspects in need of resolution Accountability, Quality and Results:
- Meets productivity standards, deadlines and work schedules; ensures that processes are implemented and revised to maintain and increase productivity
- Ensures that goals are accurately measured on a monthly or quarterly basis and progress is reported; appropriately balances quality of work with ability to meet deadlines
- Identifies and implements improvements with activities, programs, projects, services and resident interactions to meet expectations and quality initiatives based on Strategic Plan
- Generates unique but workable and useful solutions to resolve difficult problems
- Meet standards to measure staff and facility performance in managing and improving the environment of care and employee safety
- Provide a safe, functional, supportive and effective environment for residents achieving desired outcomes; improving resident quality and safety; review quality initiatives and performance improvements; ask employees for quality improvements To perform this job successfully, an individual should demonstrate the following competencies:
- Analytical - Synthesizes complex or diverse information.
- Resident/Customer Service - Manages difficult or emotional resident/customer situations; responds promptly to resident needs; solicits resident feedback in an attempt to achieve an optimum level of resident care; treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically; upholds organizational values.
- Interpersonal Skills - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to the ideas of others; and is willing to try new solutions and options; shows respect and sensitivity for cultural differences; respectfully helps to educate others on the value of diversity; promotes a harassment-free environment.
- Quality - Looks for ways to improve and promote quality; demonstrates accuracy, thoroughness, excellence and attention to detail; applies feedback to improve performance; monitors own work to ensure quality and excellence.
- Safety and Security - Observes safety and security procedures; determines appropriate action beyond guidelines; reports potentially unsafe conditions; uses equipment and materials properly.
- Organizational Support - Follows policies and procedures; completes administrative tasks correctly and in a timely manner; supports the goals and values of the organization; benefits organization through outside activities and representation of the company; supports affirmative action and respects diversity; prioritizes and plans work activities; uses time efficiently.
- Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to the views of others; gives and welcomes feedback; contributes to building a positive team spirit; puts the success of the team above his/her own interests; able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.
- Oral and Written Communication - Speaks clearly and persuasively in positive or negative situations; listens for and seeks proper clarification; responds well to questions asked; demonstrates excellent group presentation skills; participates in meetings and enrichment discussions; writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet appropriate needs; presents numerical data effectively and legibly; and is able to read and interpret written information.