Tribal Option Medical Social Worker at Cherokee Indian Hospital Authority

Cherokee, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

21 May, 26

Salary

0.0

Posted On

20 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Case Management, Discharge Planning, Resource Utilization, Care Management, Documentation, Treatment Planning, Utilization Review, Performance Improvement, Data Analysis, Counseling, Interdisciplinary Collaboration, Policy Compliance, ICD-10 Coding, Billing Practices, Strategic Planning, Liaison

Industry

Hospitals and Health Care

Description

PRIMARY FUNCTION The incumbent is responsible for all operational activities of the Social Services program. The incumbent is responsible for planning, organizing, directing, coordinating, and managing Social Services activities in order to assure meeting the needs of the member. The position also includes case management duties to assure clinically and financially responsible care. He/she maintains liaison with other departments, agencies, organizations, and community resources in determining appropriate resource utilization. JOB DESCRIPTION * Incumbent serves as the consultant to the Tribal Option staff on all matters pertaining to social work services. * The incumbent provides a wide range of social work activities to eligible Tribal Option members. * The incumbent is the official liaison and will promote and facilitate a positive professional relationship between EBCI Tribal Option and other social service and human service programs in the area. This includes all Tribal, regional, community, courts, and other medical and behavioral health facilities upon request for the Native American population served. * Services provides may include, but are not limited to the following: * Assisting members and families with discharge planning, * Arranging member transfer and transporting to and from other facilities * Referrals for financial resources * Referrals for death and dying resources and services * Referrals for advanced directive facilitation and resources * Assisting with referrals for child/adult abuse/neglect to the appropriate agencies * Through consultation, shares social evaluations and knowledge of members, their families, and community resources with physicians, planning for the treatment and/or rehabilitation of members. * Utilizes the care management platform for documentation of interventions and outcomes and interactions with individuals encountered in providing care. * Assists the Tribal Option team with the development of plans of care by assessing the member’s needs through interviews with members, relatives, and other care team members in order to obtain pertinent information. * Ensures conformance to acceptable standards of Social Service and Case Management practice, including all policies, procedures, rules, and regulations of the Cherokee Indian Hospital, JCAHO, CMS, and State Division of Medical Assistance. * Responsible for assisting with planning, developing, and implementing the Social Service program. * Implementing Social Service activities within the organization including concurrent and retrospective reviews, identification of actual and/or potential delays in service and/or treatment, and reporting trends of inappropriate utilization of resources. * Attends daily multidisciplinary inpatient rounds and confers with the Inpatient Social Worker and Medical staff on Social Services and Care Management services. * Assists the Tribal Option staff as needed with coordination of care and disposition of members, such as, but not limited to members requiring placement or transfer to any medical, non-medical and/or behavioral health facilities. * Assists the nursing and medical staff as needed with facilitation of transfer for members from outside facilities back to CIHA medical or behavioral health inpatient units. * Responsible for identifying providers or services needed to coordinate the member’s care in the Primary Care setting, or upon discharge from the Cherokee Indian Hospital or any regional facility. * Interprets member’s resource and care management needs to the Medical and Nursing staff and collaborates with them in the determining available resources. * Maintains files and prepares reports on Social Service and Case Management activities and areas for improvement for submission to the Tribal Option Care Manager Supervisor and other appropriate groups. * Participates in the development and implementation of Performance Improvement activities, and participates or leads at least one Quality Improvement activity per year (PDSA). * Attends meetings, planning sessions, committees, and serves on teams to promote quality and performance improvement. * Attends conferences and meetings relating to social service practices. * Performs other related duties as required. EDUCATION, LICENSURE, CERTIFICATION, AND EXPERIENCE * Bachelors Degree in Social Work. * At least 2 years experience as a Social Worker. Prefer that experience reflects knowledge of Hospital Social Work. * Current Basic Life Support (BLS) required for the position. Can be acquired through the facility following appointment to position. JOB KNOWLEDGE * Knowledge of principles, practices, techniques, and theories of social work in order to plan and provide social services to meet the physical, emotional, spiritual, and socio-cultural needs of members of all ages; specifically, Infancy (Birth-1 year), Toddler and Early Childhood (2-5 years), Latency (6-9 years), Preadolescence (10-12 years), Early Adolescence (13-15 years), Adolescence (16- 20), Adult (21-64 years), and Elderly (65-+ years). * Knowledge of disease process, health care treatment and systems, and treatment protocols. * Knowledge of health care financial management, provider payer mechanisms, business environment, and resource management. * Knowledge of strategic planning, outcome measurement, quantitative methods and statistics. * Knowledge of ICD_10 coding, billing practices. * Knowledge and ability to analyze the results of various medical procedures and translate into appropriate plans of care. * Knowledge of nursing home admission requirements, including steps to initiate nursing home processing. * Knowledge of the transfer/admission to inpatient process for CIHA. * Knowledge of Family Care Services policy and procedures and ability to coordinate care requirements with patient centered goals in mind. * Knowledge and ability to independently plan, manage, and organize work in order to meet priorities, accomplish work within established time frames and work in stressful situations. * Knowledge of the occupational functions of multi-disciplinary integrated health care teams. * Knowledge of the culture and health profile of the member population. * Knowledge and ability to teach and counsel member/family and staff on plans for care and use of health care resources. * Knowledge of available health care programs and community resources. * Knowledge of processes and procedures for establishing, revising, continually monitoring, and evaluating standards for Social Services. * Knowledge of medical record documentation and how to perform medical record reviews. * Ability to communicate to and interact with persons, (staff, health care professionals, individuals in the community) with different functions, levels of knowledge, and requirements. * Knowledge of JCAHO accreditation standards, social services quality improvement standards, HCFA regulations, Medicare, Medicaid, and private insurance. * Knowledge of clinical teaching methodologies and methods of evaluating the effectiveness of teaching strategies. * Ability to gather and analyze data and communicate findings. COMPLEXITY OF DUTIES Guidelines consist of professional standards of practice, medical policies and procedures. Must, also, comply with Compliance Plan, Utilization Review Plan, State and Federal guidelines, CMS, FPM, DHHS, PHS, and IHS regulations. These guidelines are not always specifically applicable to the individual member or situation and independent judgment is required in selecting the most appropriate guideline, and applying the intent. Requirements are complex in that they require comprehensive skills in Social Services and Care Management and have sufficient knowledge of medicine to evaluate member care. This may involve difficult interactions with the clinical staff, case managers, care managers, and insurance payers and require maximum skills in diplomacy and judgment. SUPERVISION RECEIVED: Incumbent receives administrative guidance from the Tribal Option Care Manager Supervisor. Works within the framework of regulations, policies, and procedures established by the agency, CMS, and North Carolina Division of Medical Assistance. Further guidance is received from Professional Literature, Indian Health Service Manuals, and Program Area Directives. Is expected to exercise a high degree of independent initiative and judgment in development and implementing new approaches to the delivery of quality care. Functions with a minimum of guidance and supervision. The Tribal Option Care Manager Supervisor sets the overall objectives and resources available. RESPONSIBILITY FOR ACCURACY The incumbent’s performance affects the health, recovery, and rehabilitation of members, and the quality of care provided. Evaluations and observations are used to modify and develop clinically and financially appropriate treatment plans. The incumbent has a positive effect upon the recovery of the member and is responsible for the development of policies and procedures, which serve as hospital guidelines. CONTACTS WITH OTHERS Contacts are with members of all ages, families, hospital personnel, community agencies, and insurance carriers. Contacts with members, families, and hospital personnel are to exchange, provide, and obtain information concerning the member’s physical and psychosocial health care problems and needs. Contacts with other health care or related disciplines and insurance carriers are for the purpose of coordination, collaboration, and consultation in meeting the member’s health care needs. CONFIDENTIAL DATA The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical, and all other pertinent information that comes to his/her attention or knowledge. The Act carries both civil and criminal penalties for unlawful disclosure of records. Violations of such confidentiality shall be cause for adverse action. MENTAL/ VISUAL/ PHYSICAL Work in the various services within the Tribal Option department is mostly sedentary, yet requires walking, standing, bending, pushing, and lifting in helping members to and from beds, wheelchairs, and stretchers. These same activities are required in moving equipment and medical supplies. Will be subject to frequent interruptions requiring varied responses, which can cause distractions therefore, the incumbent must possess the ability to differentiate and prioritize many tasks at once. ENVIRONMENT Must be flexible in working hours. This position offers a hybrid work model, with the flexibility to work remotely or from the designated work space. Specific workdays and location will be determined in collaboration with the Tribal Option Care Manager Supervisor. The incumbent may occasionally be required to perform care management duties and tasks within the clinical setting. Incumbent is required to comply with Employee Health Program guidelines including current immunization status of identified communicable diseases and safety precautions are sometimes necessary, such as use of personal protective equipment as required by hospital policy. The work environment involves moderate risks of exposure to infectious disease, radiation, electrical hazards, irritant chemicals and explosive gases. Some travel is required. Infrequent overnight travel may be required for meetings or to attend training. CUSTOMER SERVICE Consistently demonstrates superior customer service skills to members/customers by demonstrating characteristics that align with CIHA’s guiding principles and core values. Ensure excellent customer service is provided to all members/customers by seeking out opportunities to be of service.

Responsibilities

The incumbent manages all operational activities of the Social Services program, including planning, directing, and coordinating services to meet member needs, while also performing case management duties for clinically and financially responsible care. This role involves maintaining liaison with external departments and agencies to ensure appropriate resource utilization and assisting in the development and implementation of the Social Service program.