Social Worker III -North Adams Regional Hospital, Case Management, Shift: Days, 16hrs

The Case Manager is responsible for managing the healthcare needs, facilitation and achievement of quality and cost outcomes of all patients within Berkshire Medical Center, across the continuum. The case manager, utilizing a multidisciplinary team approach, negotiates, procures, coordinates and monitors services and resources needed by patients. The case manager is responsible for reviewing the patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for the appropriate level of care and utilization of resources. The case manager will perform transition care planning activities to secure appropriate post hospital care arrangements and will monitor the patient during the course of their hospitalization. The case manager participates with the performance improvement initiatives undertaken by Berkshire Health Systems.

Experience

• Three years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, oncology, psychiatry
• Three years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
• Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
• Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence-based criteria tools), discharge planning to entities throughout a continuum of care, previous care management or third-party insurance review preferred
• Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required
• Current knowledge of Kepro QIO (appeals) required
• Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and HealthGrades preferred

Education and Training

• Masters Social Work

License, Certification & Registration

• LCSW-Licensed Clinical Social Worker required
• LICSW preferred

Other Requirements

• Organizational skills
• Proven ability to analyze and present data
• Computer literacy
• Ability to plan, implements, and evaluate change
• Data management skills preferred
• Proven excellent interpersonal and communication skills
• Ability to maintain confidentiality
• Proven collaboration and negotiation skills with providers, patients, families, insurance organizations and government agencies
• Proven ability to work independently
• Proven excellent organizational skills
• Demonstrated ability to establish and maintain relationships with physicians
• Knowledge of local community resources required
• Knowledge of Medicare, Medicaid, third party commercial payers and reimbursement required
• Computer experience required with proven ability to manage multiple open applications
• Skills in data comprehension, research, analysis, interpretation and judgement necessary to prepare a comprehensive summary report for files, management, legal and/or regulatory agencies upon request

Schedule

• 10am-6:30pm
• Variable Days

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)