Case Manager / Social Worker / Rehab at Emory Healthcare

Atlanta, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

04 Sep, 26

Salary

40.37

Posted On

06 Jun, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Case Management, Discharge Planning, Utilization Review, Patient Assessment, Crisis Counseling, Regulatory Compliance, Interdisciplinary Collaboration, Medical Necessity Review, Patient Education, Resource Coordination

Industry

Hospitals and Health Care

Description

Overview Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs...and more! Description Assesses, implements, coordinates, and monitors options and services to meet health needs of patients using communication and available resources to promote quality, cost effective outcomes. Validates appropriateness of inpatient rehabilitation hospital admissions according to nationally recognized standards. Reviews inpatient and observation cases for compliance with the Utilization Review Plan filed with the State of Georgia. Takes appropriate action to comply with third party payor requirements. Knowledgeable in state and federal regulatory requirements; I.e., Medicaid, Medicare. Provides emotional support to patients. Reviews each hospital admission in accordance with nationally recognized criteria and department policies to determine the medical necessity of admission and appropriate length of stay (LOS). Intervenes as required with physicians and Interdisciplinary Patient Care Teams to facilitate achievement of targeted LOS. Issues and administers notices of non-coverage and potential liability to clients in accordance with predetermined regulations, policies and procedures. Facilitates MD to MD reviews as needed. Maintains an effective flow of information between nursing units, physicians, Medical Records, Business Office and third party payors to facilitate appropriate LOS and to ensure appropriate reimbursement and coverage. Maintains a cooperative relationship with professionals, physicians and community agency representatives. Efficiently covers for colleagues as requested, and thoroughly conveys patient care status and plan of care in order to assure continuity and uninterrupted service upon colleagues return. Thoroughly prepares covering colleagues in advance of planned absences. Demonstrates the skills necessary to nurture team building and growth in establishing and maintaining a cooperative relationship with professionals, physicians, patients, family members and community agency representatives. Assess patients and members of their support system in order to identify potential needs, to determine appropriate level of care for discharge planning purposes and to identify necessary interventions. Evaluates family, home environment and financial situation in order to develop safe and viable plan of care. Provides patient and family education regarding discharge planning and community resources. Provides supportive counseling for patients, families and significant others who are experiencing anxiety or stress due to illness, injury or physical limitations. Evaluates, coordinates and acts in accordance with current laws and hospital policies in reporting targeted populations (suspected child/disabled adult/elder abuse or neglect). Collects and records required Utilization Management information for appropriate management of the patients in the rehabilitation units. Acknowledges and appropriately prioritizes referrals from interdisciplinary team members, patients, and families with initial chart documentation entered within 24 hours of receipt of consult except for holidays and weekends. Attends and actively participates in meetings in order to screen for high risk patients, obtain and share information, identify appropriate length of stay. Maintains focus on the provision of quality service in a rapid and efficient manner in order to transition patients to the appropriate level of care within the time frame of the target length of stay. Updates the clinical team regarding discharge destination, and date and time of anticipated discharge. Collaborates with insurance case managers and community care providers, and initiates referrals to appropriate community resources. Maintains a thorough working knowledge of Medicare, Medicaid and private payor regulations and processes and a broad knowledge of resources and options for patients available within all levels of care; facilitates efficient access and movement of patient across levels of care, and coordinates inter-facility transfer of patients to appropriate level of care. Respects the confidentiality of all patient information and conforms to hospital/departmental policies. Acts as a responsible steward of department's and patient/family's patient care funds. Works with manager to formulate plan for professional development. Attends educational in-services as appropriate. Participates in professional activities and organizations to maintain knowledge of current trends, practices and developments. Maintains accurate, legible, confidential documents and records pertaining to medical reviews in accordance with departmental policy. Completes all necessary paperwork and computer documentation in order to assure accurate reimbursement to the organization and compliance with regulatory requirements. Completes additional assignments/projects as directed by department leaders. Supports and participates in multidisciplinary patient/family education and care planning with the entire healthcare team. Develops educational and resource materials and programs to meet the needs of assigned patient population, and to meet the education needs of the medical team and peers. In collaboration with supervisor, pursues professional development opportunities through local, regional and national forums. Acts as a professional resource for colleagues within and outside the organization. Provides education to the community as needed. Performs other related duties as required. MINIMUM QUALIFICATIONS: Masters in Social Work from an accredited Institution. At least 1 year experience preferred, experience in an Acute Care setting preferred. Knowledge of software applications. ACM, CCM preferred. PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock , Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation , Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks. Additional Details Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

Responsibilities

Coordinates and monitors health services and discharge planning to ensure quality, cost-effective patient outcomes. Manages utilization reviews and ensures compliance with state and federal regulatory requirements for inpatient rehabilitation.