Under the general supervision of the Supervisor and/or Manager, and according to established policies and procedures, coordinates, negotiates, and manages the care of patients to facilitate achievement of positive clinical and financial outcomes. Works collaboratively with interdisciplinary staff, internal and external to the organization, to facilitate appropriate delivery of healthcare services. The Case Manager MSW integrates the roles of Case Management and Discharge Planning utilizing a prospective approach for planning the ways in which patient care will be provided, the steps in the care process, and the outcomes of care. This role's objective is to promote a collaborative interdisciplinary care delivery model to achieve optimal clinical, satisfaction, and financial outcomes. The Case Manager MSW participates in quality improvement and evaluation processes related to management of patient care. Work is of a highly confidential nature.
Education: Master's Degree from an accredited school of Social Work.
Experience: One year of clinical experience in at least one of the following areas: Case Management, Social Work and/or Discharge planning. Preference will be given to those with hospital experience.
Licensure/Certification: Currently licensed by the State Board of Social Work Examiners for S.C. Preference will be given to those with Case Management Certification.
Primary Source Verification (if applicable): Social Worker-
Labor, Licensing and Regulation (LLR): http://verify.llronline.com/LicLookup/LookupMain.aspx
Knowledge/Skills: Demonstrates knowledge of community resources, government and commercial payer programs benefits and eligibility, and post-acute service regulatory requirements. Demonstrates knowledge of reimbursement systems, the ability to educate patients and families regarding payer requirements / coverage for post-acute care services and the ability to effectively advocate on behalf of the patient to obtain authorizations for continued care as appropriate. Maintains working knowledge of post -transition of care options based on facilities capabilities and funding accepted. Maintains a working relationship with external providers, services, agencies to facilitate the transition of care. Requires high level negotiation skills and confidence in communicating with and engaging in crucial conversations with physicians and entire healthcare team.
Other: Requires excellent oral and written communications skills. Ability to work in a fast pace team environment. Ability to prioritize and multi-task. Ability to make sound judgements and act professionally under pressure. Ability to maintain confidentiality of sensitive patient information. Must have ability to solve problems independently, prioritize work and design creative solutions when resources or options for discharge are limited.
Contacts: Frequent interaction with interdisciplinary healthcare team, patients/families/caregivers, insurance companies, community organizations, vendors, and regulatory agencies.