Social Worker

Description

JOB PURPOSE AND SUMMARY

The Case Manager identifies and implements the degree of case management necessary to ensure that the patient/family receive optimal benefits from the care and treatment provided within the healthcare system, utilizing referral resources, as necessary. Working within the multidisciplinary health care team, the Case Manager ensures coordination of patient care and wise utilization of health system resources serving as a liaison between the healthcare system, insurance and state/government entities to ensure that financial coverage for the patient is approved by the carrier/agency. The Case Manager performs a wide variety of tasks including assisting with the development of an individualized case management plan to address physical, emotional, and financial needs. The Case Manager is an advocate on behalf of the patient/family.

A Medical Social Worker is responsible for the provision of social work services to patients and families, including but not limited to, individual and family assessment, crisis intervention, and ongoing case work. The Medical Social Worker actively participates within the department through staff meetings, interdisciplinary team meetings and committees, etc. The Medical Social Worker has a strong knowledge base regarding child development and family systems, which is incorporated into the pediatric setting. A Social Worker demonstrates the knowledge and skills necessary to provide age-appropriate social work services. The Medical Social Worker also has demonstrated knowledge of and skills in collaborative planning along with an understanding of the health care system. The Medical Social Worker has knowledge of community resources and refers patients and families to suitable resources in the community.

The position of Case Manager can be filled by a Medical Social Worker, given that their qualifications meet the requirements of the position. In the event of a Medical Social Worker fulfilling the role of Case Manager at CHONC, their job description would include both sets of responsibility outlined here.

Social Work position is for Saratoga Pediatric Subacute and Children's Recovery Center as needed. 

CASE MANAGER DUTIES AND RESPONSIBILITIES:

1. Assists in the development and implementation of the case management program:
a. Participates in care planning continuum
b. Assists in the design and implementation of systems to increase multidisciplinary team involvement in the case management program.
c. Collaborates with existing programs/departments to ensure appropriate resource utilization

2. Performs a comprehensive case management assessment of patients to identify the patient care needs and coordinates the case management activities in the hospital:
a. completes a comprehensive assessment of patient/family goals, psychosocial, physical and functional needs.
b. assists the multidisciplinary health care team in developing an individualized patient care plan.
c. reviews the case management plan with the patient/family within 2 weeks of patient admission in order to align the plan with patient/family goals.
d. reviews care/treatment regularly and compares the patient/family progress with the case management plan.
e. Documents information from the insurance criteria and coordinates multidisciplinary communication to facilitate re-assessment and revision of the case management plan as necessary.
f. Coordinates discharge planning assessment, anticipates discharge needs and makes appropriate suggestions for referrals, including linking the patient/family to resources within and outside of the health care system.
g. coordinates team conferences to ensure timely responsiveness to patient/family needs.
3. In coordination with the billing department, maximizes positive financial outcomes:
a. Ensures authorization for services, including payor eligibility decisions and authorizations for diagnostic tests, treatments, medications, therapies, visits, and other referrals, etc.
b. Performs utilization review as necessary.
c. Possesses appropriate medical knowledge in order to effectively communicate medical needs for hospitalization and treatment plan to the insurance carrier/government agencies.
4. Collaborates with appropriate team members to ensure optimal reimbursement through appropriate documentation.
a. Ensures patient/family are obtaining appropriate level of services by communicating effectively within the health care system with outside agencies, coordinating the flow of information, and assuring that the required elements of care/service are appropriately documented.
b. Assists the multidisciplinary health care team in wisely coordinating and facilitating utilization of health care resources to assure continuity of care and optimal medical outcomes.
5. Maintains a reference network of health systems and community resources/referrals.
6. Provides legible documentation to reflect case management needs, goals, and planned interventions.
7. Referral to and collaboration with Early Intervention Programs.
a. Coordination with local or state agencies and programs providing services to children such as the Regional Center, California Children’s Services, Child Protective Services.
8. Coordinates discharge planning, and assists in preparing patient and family educationally, and functionally for discharge.
a. Includes the arrangement of services and equipment for patients to be discharged.

SOCIAL WORK DUTIES AND RESPONSIBILITIES:
1. Completes comprehensive psychosocial assessment of patients and families and develops treatment plan based on assessment.
a. Participate in development of a patient-oriented care plan
2. Provides psychosocial support and counseling including crisis intervention, individual, group, and family counseling, and community referrals.
3. Collaborates with multidisciplinary care team informally and formally through multidisciplinary care rounds and facility meetings.
a. Inform the team on the social, psychological and emotional needs of the family/patient
b. Standardize methods in which social services tasks are performed
4. Completes mandatory reporting of suspected abuse (Child, Elder or Domestic Violence)
5. Supervision provided by Director of Nursing/Chief Nursing Officer.
6. Participates in continuing education, including departmental in-services.
a. Provide residents with information concerning rights, living wills, etc.
b. Assist families with seeking financial advice, discharge planning and referrals
7. Completes chart documentation, statistical forms for facility, abuse reporting forms, and all other communications required to complete his/her assignment.
8. Develops appropriate social work programs for CHONC.
9. May be responsible for teaching and/or supervision of social work interns or other allied health professionals.
10. Completes special tasks as requested by Director of Nursing/Chief Nursing Officer

Qualifications

QUALIFICATIONS:

• Bachelor's degree in social work.
• Previous experience working in a health care setting, demonstrated knowledge of child development and family dynamics preferred
• Training in Utilization Review, Discharge Planning, and/or Case Management preferred.
• Excellent interpersonal/communication skills.

PHYSICAL AND SENSORY REQUIREMENTS:

• Must be able to move intermittently throughout the day.
• Must be able to speak and write English language in an understandable manner.
• Must be able to cope with the mental and emotional stress of the position
• Must possess sight/hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met

WORKING ENVIRONMENT

• While performing the duties of this job, the employee occasionally works near moving mechanical parts and is occasionally exposed to toxic or caustic chemicals, risk of radiation and vibration.
• The noise level in the work environment is usually moderate.
• The employee must be able to work near other co-employees and concentrate efforts on tasks despite noise, interruptions, and general commotion.

Salary : $36 - $40