Summary:
The Master of Social Work (MSW) Case Manager plays a pivotal role in maintaining the quality of care patients receive during medical centerization and post discharge while ensuring the organization is fully reimbursed. The MSW Case Manager (CM) must have a high level of expertise and skill to create highly effective strategies for short term and long term goals in order to prevent readmissions and address unpredictable situations. MSW CM must be proficient in planning, executing and monitoring effectiveness of the care provided to ensure timely transition through the continuum of care. Educating and consulting with the physician and the health care team to ensure accuracy of medical necessity criteria and to ensure timely and appropriate level of care is achieved. This requires effective skills in conflict resolution, decision making and team building. The MSW Case Manger practices in accordance with the care management process utilizing tools, standards, models, goals and objectives, and performance improvement concepts. The MSW Case Manager provides pertinent clinical data to outside agencies as needed to assure compliance with their requirements and represents the organization professionally. The ability to analyze, evaluate and distribute resources and educational information to ensure understanding of services to all educational level is key to the role. The social worker is responsible for assessing the patient's psychosocial-spiritual needs, education and counseling.
Responsibilities:
(30%)* Provide social work intervention as it relates to hospitalization including crisis management, health care decision making, illness adjustment, ethical/legal concerns, discharge planning, and transitional care needs, child or elder abuse, domestic violence, competency, financial problems, compliances issues, substance abuse, mental illness as well as other psychosocial barriers to maximizing health status.
(30%)* Work with health care team, patient, family and/or significant others to continually transition the patient to the appropriate level/place of care. Advocate, mediate, and negotiate, with an emphasis on self-determination for the patient system, to formulate a cohesive plan for maintaining the patient's health status, improving social supports, and moving the patient safely into less restrictive, less costly levels of care according to available resources.
(20%)* Collaborate with the physician in competency/capacity determination, obtaining legal guardianship, involuntary psychiatric admission, adoptions, ethical concerns, etc. Complete and disseminate all necessary legal and clinical documentation as needed for resolution.
(20%)* Collaborates with all members of the Care Management Team including physicians, nurses, health information analysts, and others to provide information relating to admission, continued stay, discharge criteria, managed care, federal program regulations, reimbursement fundamentals, and regulatory standards on a daily basis.
OTHER DUTIES AND RESPONSIBILITIES:
Complete and document a standard social work psychosocial-spiritual assessment to: Eliminate barriers to treatment, increase patient/family satisfaction, improve appropriate utilization of resources.
Serve as the lead in obtaining financial and other resources for patients and families in need.
Identify the need for and conduct family meetings, with or without the physician, that result in understanding, comfort, decision-making, and other important outcomes.
Integrate relevant theories of family dynamics, crisis intervention, strengths based, solution focused, and meaning of illness into everyday casework.
Summarize a patient and family situation concisely, with helpful guidance to non-social work staff members about recommendations for actions to be taken and barriers to discharge.
On specific units, analyzes the clinical information on admission, concurrently, and retrospectively (per medical necessity criteria/InterQual Guidelines) to assure quality care is being provided to the patient, in the appropriate location, on a daily basis.
Determines the necessity for second-level review and implement process per hospital policy.
Collaborates with physicians to determine appropriate patient status and successfully negotiates patient status with the payer.
Facilitates discharge planning for patients i.e. extended care placements, other facility transfers, and home care arrangements in collaboration with the health care team.
Actively participate in care coordination efforts to successfully identify high-risk factors and respond appropriately so that key information, next steps and avoidable days are captured and documented. Is an active participant in the daily care coordination meetings.
Accepts accountability for the clinical outcomes that the Utilization Review and Discharge Planning role can facilitate.
Maintains timely, clear and concise documentation in all required systems.
Provides pertinent clinical data to designated outside agencies to assure compliance with their requirements.
Assures compliance with regulatory requirements and acts a resource/liaison to physicians and medical staff regarding all aspects of Case Management activities.
During Care Coordination Rounds, MSW CM communicates with the health care team a patient-centered plan that is needs based, appropriate to patient resources, timely and addresses the risk of readmission.
Builds professional relationships with patient, families, facilities and resources to address conflict resolution with positive outcomes.
Completes all documentation and data entry requirements. Identifies high risk population and addresses opportunities for intervention.
Willingly and consistently offer to help peers as needed.
Communicates teamwork, caring and compassion. Provide excellent customer service with internal and external customers.
Assume responsibility for professional development and education requirements for maintenance of professional licensure.
All other duties as assigned.
Certifications and Licensures:
Credential:MSW: Masters of Social Work
Equivalent Experience: Limited License MSW employees must be actively working to obtain full licensure. These employees must pass licensing exam and work 4,000 hours supervised by a LMSW. Certification in Case Management preferred. Recommended that the Case Manager receives their ACM certification after two years of experience.
Qualification Source: MI
Essential: true
Required Education:
Education: Master's Degree
Equivalent Experience:
Education Specialization: SOCWRK
Essential: true
Other Information:
EXPERIENCE, TRAINING AND SKILLS:
Training and experience, and/or demonstrated competency in casework principles, including diagnosis, assessment, crisis intervention, treatment and transition planning; techniques in individual, family and group therapy; awareness of community resources, public assistance and entitlement programs, ensuring transition to appropriate levels of care; and issues relating to age and stage of development, special needs and cultural patterns of the patient populations being served.
Knowledge of medical social work practices, processes and procedures as normally acquired through three years experience working in a medical center (preferred), social agency or community organization dealing with physical and/or mental health and/or welfare.
Interpersonal skills needed to communicate successfully with individuals and groups and interact with people at all levels to communicate ideas and concepts in a clear and understandable manner.
Adherence to the National Association of Social Workers Code of Ethics.
MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health.
Membership in at least one professional organization (i.e. NASW, Society for Social Work Leadership in Health Care (SSWLHC)-MI Chapter, national SSWLHC, etc.) preferred.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:
Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Overall vision and hearing is necessary with or without assisted device(s).
Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.
Other Comments:
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