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SalaryPosition Summary
The Case Manager/Medical Social Worker is responsible for performing case management, utilization review, quality assurance, and discharge planning. Responsibilities specific to Case Management include assessment, identification of specific needs, and social service intervention while in the acute setting. Awareness of services available to patients and their families are an important part of this assessment. Responsibilities specific to Utilization Review include performing admission and concurrent review, and at times retro-review of all in-patients conforming to Medicare and Medi-Cal requirements. These review processes may be applicable also to Contracted Managed Care members who are patients in the acute/ extended care units of the hospital. Issuance of non-coverage letters at time of discharge to the acute/extended care patient is also considered part of the discharge planning process as specified by contracted Health Plans and HCFA. Responsibilities specific to Quality Assurance include performing surveillance and data collection as directed for trend recognition and development of effective actions/plans.
General Expectations from ALL Employees:
• Treat all patients and colleagues with dignity and respect. Have open communication between all departments and cultivate a team environment. Listen to all points of view when problem solving and collaborate as a team. Follow all hospital/ department policies and procedures. • Annual Medtrainer to be completed before the deadline. • Follow appropriate chain of command when addressing any hospital or department issues. • Attendance is paramount to a successful department and team. It is expected that each staff member will arrive to work with enough time to conduct the appropriate change of shift functions with unapproved OT. • All time off will be requested in the appropriate manner and before the schedule is published. • Working weekends and holidays are a required part of working in inpatient bedside healthcare, and will be determined by department managers. • Holiday schedules will be determined and published by the department managers base on unit needs. • Company equipment, supplies, and time will be used only for company activities, not personal activities.
Expectations from CNO: Welcome to the team!! It is the expectation that you function as a cohesive member of this team, with a “Can- Do” attitude in all situations. It is also the expectation that you will be flexible as we grow and our environment develops.
Essential Duties & Responsibilities
• Demonstrates professional Responsibility in the role of Case Manager/ social worker. • Complies with policies and protocol set forth by the facility. • Maintains confidentiality when interacting with patients, families, personnel, and the public population. • Maintains compliance with state/ federal guidelines for AZ, TJC, and CMS. • Conforms to all requirements of Medicare/Medi-Cal • Keeps current on changing laws/ requirements of Medicare/ Medi-Cal • Reports any problems to the CNO in a timely manner. • Provides information in response to queries from the public, doctors’ offices, families, and outside facilities. • Provides case management, social services, utilization review and discharge planning daily. • Participates in continuing education and other pertinent and appropriate learning experiences to maintain and increase personal and professional growth. • Participates in current continuing education that is relevant to the field of expertise of current practice. • Utilizes workspace and equipment in an appropriate, professional manner to enhance patient outcome. • Workspace is only used for completion of work assigned by job duties. • Makes additional notes and documents conversations with other members of interdisciplinary team. These notes nay also include conversations with caregivers, families, and other support systems involved with the care of the patient. • Refers patients to necessary establishments (home health care, hospice services, skilled nursing facilities, rehabs, etc) • Acquires physician orders and signatures on transfer sheets, financial verification, insurance approval and transfer permits will need to be obtained, and transportation arranged. • Does inpatient insurance reviews that are requested daily, utilizes the acuity assessment form and notes review outcomes, contacts and requests for further review times for follow-up. • Provides information regarding Advance Directives, assists in filling out the forms, and obtaining non-employed witnesses to complete the documentation of Advance Directives. Makes photocopies for the patient and places a copy in the chart or sends it to Medical Records for filing in the chart at any time • Performs surveillance and data collection as directed for trend recognition and development of effective actions/plans • Maintains confidentiality when interacting with patients, families, personnel and the pubic • Responds in a timely manner to requests from inter-disciplinary team members, physicians and their office staff, administration, industrial medicine and public agencies • Reviews patient charts when a request for counseling is received • Reviews and assesses need for intervention and/or appropriate community resources for all newborns in Obstetrics and/or adults under medically supervised care
Safety & Infection Control
Customer Service
• Gives care that demonstrates the concierge level service taught at this facility. • Goes the extra mile for patients when they are in our care. • Demonstrates effective interpersonal skills • Maintains confidentiality of patient related issues in accordance with HIPAA standards. • Treat all patients, visitors, and staff members fairly and with respect. • Utilize effective communication methods and skills • Explain/ educate on all procedures, treatments, and care while remaining aware of language barriers. • Able to perform care in non-judgmental manners and recognize discrepancies between patient and personal beliefs.
EHC Policy
• Ensure personal appearance is clean and neat. • Responsible for always wearing identification on upper part of uniform when in the facility. • Attend ALL IP required meetings and in-service education. • Responsible for complying with all compliance standards including annual MedTrainer competencies, and annual skill fair competencies. • Remain flexible in staffing patterns and staffing resolutions when conflict arises. • Participates in the team environment. • Demonstrate flexibility when changes in assignments are necessary to promote safe patient care. • Compliance with all attendance standards.
Qualifications
• Education & Experience: o Graduated from an accredited school of nursing, BSN preferred. o At least 2 years of experience in a hospital setting. • Basic Skills o Ability to read and comprehend simple instructions. o Ability to effectively present information to patients/ families/ team members o Ability to perform med math calculations/ height and weight calculations o Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. o Ability to problem solve with multiple variables in situations. • Computer Skills o Basic computer skills/ charting system knowledge. • Certifications/ Licensing: o Current unencumbered RN license in the state of practice. o Current BLS and ACLS (PALS preferred)
Competencies
• Professional Maturity: The ability to separate emotional feelings/ personal life from the real issues at hand in the work place. • Responsibility: The ability to accept choices you have made and the results they have led to. • Communication: The ability to write and speak effectively, actively listens to others, and give feedback. • Flexibility: Demonstrate responsiveness and adaptability following change initiatives. • Intelligence: Understand information and apply ne knowledge. • Energetic: Exhibits high levels of energy and enthusiasm to care for people. • Organized: Efficient in structuring tasks to be accomplished. • Computer Savvy: The ability to use technology efficiently and effectively. • Customer Service: The ability to enhance patient satisfaction. • Job Knowledge/ Technical Knowledge: Knowledgeable of current role and technical systems, and the impact it has on the organization. • Integrity and Respect: Demonstrates upmost level of integrity. • Interpersonal Communication: Writes and speaks effectively based on psychological, relational, situation, environmental and cultural dynamics within the situation. • Collaboration and partnership: Encourages participation from team members. • Manages Changes: Demonstrates flexibility with changing environments. • Problem Solving: Resolves issues in a professional and timely manner. • Attention to Detail: Follow procedures to ensure entry of information. • Organization: Uses time effectively by prioritizing and planning work activities. • Judgement: Ability to make independent decisions. • Teamwork: Works with others to accomplish objectives and shows support for decisions. • Quality: Sets high standards to ensure quality in work performance. • Accountability: Takes responsibility for adhering to all company policies, procedures, and performance expectations. • Competent in HIPAA, OSHA, and EMTALA regulations
Physical Demands
• Ability to climb, stoop, kneel, reach, stand, walk, pull, push, lift, and able to exert up to 40 pounds of force occasionally and/or up to 10 pounds of force constantly to move objects. • Moderate physical activity performing somewhat strenuous daily activities of a clinical/ clerical nature. • The physical demands for this position include: adequate vision, hearing, and repetitive motions. • Substantial movements of the wrist, hands, and/ or fingers in a repetitive manner. • Use of feet and legs and/ or hands and arms in a repetitive manner. • Bending legs downward and forward by bending leg and spine. • Standing, particularly for sustained periods of time. • Raising objects from a lower to higher position or moving objects horizontally from position to position. • Using upper extremities to exert force in order to draw, drag, haul or tug objects in a sustained motion.
Work Environment
• Well lighted, heated and/or air-conditioned indoor clinical setting with adequate ventilation. • Clean environment to promote safe patient care
The Case Manager/Medical Social Worker is responsible for performing case management, utilization review, quality assurance, and discharge planning. Responsibilities specific to Case Management include assessment, identification of specific needs, and social service intervention while in the acute setting. Awareness of services available to patients and their families are an important part of this assessment. Responsibilities specific to Utilization Review include performing admission and concurrent review, and at times retro-review of all in-patients conforming to Medicare and Medi-Cal requirements. These review processes may be applicable also to Contracted Managed Care members who are patients in the acute/ extended care units of the hospital. Issuance of non-coverage letters at time of discharge to the acute/extended care patient is also considered part of the discharge planning process as specified by contracted Health Plans and HCFA. Responsibilities specific to Quality Assurance include performing surveillance and data collection as directed for trend recognition and development of effective actions/plans.
General Expectations from ALL Employees:
• Treat all patients and colleagues with dignity and respect. Have open communication between all departments and cultivate a team environment. Listen to all points of view when problem solving and collaborate as a team. Follow all hospital/ department policies and procedures. • Annual Medtrainer to be completed before the deadline. • Follow appropriate chain of command when addressing any hospital or department issues. • Attendance is paramount to a successful department and team. It is expected that each staff member will arrive to work with enough time to conduct the appropriate change of shift functions with unapproved OT. • All time off will be requested in the appropriate manner and before the schedule is published. • Working weekends and holidays are a required part of working in inpatient bedside healthcare, and will be determined by department managers. • Holiday schedules will be determined and published by the department managers base on unit needs. • Company equipment, supplies, and time will be used only for company activities, not personal activities.
Expectations from CNO: Welcome to the team!! It is the expectation that you function as a cohesive member of this team, with a “Can- Do” attitude in all situations. It is also the expectation that you will be flexible as we grow and our environment develops.
Essential Duties & Responsibilities
• Demonstrates professional Responsibility in the role of Case Manager/ social worker. • Complies with policies and protocol set forth by the facility. • Maintains confidentiality when interacting with patients, families, personnel, and the public population. • Maintains compliance with state/ federal guidelines for AZ, TJC, and CMS. • Conforms to all requirements of Medicare/Medi-Cal • Keeps current on changing laws/ requirements of Medicare/ Medi-Cal • Reports any problems to the CNO in a timely manner. • Provides information in response to queries from the public, doctors’ offices, families, and outside facilities. • Provides case management, social services, utilization review and discharge planning daily. • Participates in continuing education and other pertinent and appropriate learning experiences to maintain and increase personal and professional growth. • Participates in current continuing education that is relevant to the field of expertise of current practice. • Utilizes workspace and equipment in an appropriate, professional manner to enhance patient outcome. • Workspace is only used for completion of work assigned by job duties. • Makes additional notes and documents conversations with other members of interdisciplinary team. These notes nay also include conversations with caregivers, families, and other support systems involved with the care of the patient. • Refers patients to necessary establishments (home health care, hospice services, skilled nursing facilities, rehabs, etc) • Acquires physician orders and signatures on transfer sheets, financial verification, insurance approval and transfer permits will need to be obtained, and transportation arranged. • Does inpatient insurance reviews that are requested daily, utilizes the acuity assessment form and notes review outcomes, contacts and requests for further review times for follow-up. • Provides information regarding Advance Directives, assists in filling out the forms, and obtaining non-employed witnesses to complete the documentation of Advance Directives. Makes photocopies for the patient and places a copy in the chart or sends it to Medical Records for filing in the chart at any time • Performs surveillance and data collection as directed for trend recognition and development of effective actions/plans • Maintains confidentiality when interacting with patients, families, personnel and the pubic • Responds in a timely manner to requests from inter-disciplinary team members, physicians and their office staff, administration, industrial medicine and public agencies • Reviews patient charts when a request for counseling is received • Reviews and assesses need for intervention and/or appropriate community resources for all newborns in Obstetrics and/or adults under medically supervised care
Safety & Infection Control
- Demonstrate knowledge of and adhere to regulations and Er policies and procedures pertaining to safety, emergency preparedness, infection control, OSHA, fire safety and hazardous materials.
Customer Service
• Gives care that demonstrates the concierge level service taught at this facility. • Goes the extra mile for patients when they are in our care. • Demonstrates effective interpersonal skills • Maintains confidentiality of patient related issues in accordance with HIPAA standards. • Treat all patients, visitors, and staff members fairly and with respect. • Utilize effective communication methods and skills • Explain/ educate on all procedures, treatments, and care while remaining aware of language barriers. • Able to perform care in non-judgmental manners and recognize discrepancies between patient and personal beliefs.
EHC Policy
• Ensure personal appearance is clean and neat. • Responsible for always wearing identification on upper part of uniform when in the facility. • Attend ALL IP required meetings and in-service education. • Responsible for complying with all compliance standards including annual MedTrainer competencies, and annual skill fair competencies. • Remain flexible in staffing patterns and staffing resolutions when conflict arises. • Participates in the team environment. • Demonstrate flexibility when changes in assignments are necessary to promote safe patient care. • Compliance with all attendance standards.
Qualifications
• Education & Experience: o Graduated from an accredited school of nursing, BSN preferred. o At least 2 years of experience in a hospital setting. • Basic Skills o Ability to read and comprehend simple instructions. o Ability to effectively present information to patients/ families/ team members o Ability to perform med math calculations/ height and weight calculations o Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. o Ability to problem solve with multiple variables in situations. • Computer Skills o Basic computer skills/ charting system knowledge. • Certifications/ Licensing: o Current unencumbered RN license in the state of practice. o Current BLS and ACLS (PALS preferred)
Competencies
• Professional Maturity: The ability to separate emotional feelings/ personal life from the real issues at hand in the work place. • Responsibility: The ability to accept choices you have made and the results they have led to. • Communication: The ability to write and speak effectively, actively listens to others, and give feedback. • Flexibility: Demonstrate responsiveness and adaptability following change initiatives. • Intelligence: Understand information and apply ne knowledge. • Energetic: Exhibits high levels of energy and enthusiasm to care for people. • Organized: Efficient in structuring tasks to be accomplished. • Computer Savvy: The ability to use technology efficiently and effectively. • Customer Service: The ability to enhance patient satisfaction. • Job Knowledge/ Technical Knowledge: Knowledgeable of current role and technical systems, and the impact it has on the organization. • Integrity and Respect: Demonstrates upmost level of integrity. • Interpersonal Communication: Writes and speaks effectively based on psychological, relational, situation, environmental and cultural dynamics within the situation. • Collaboration and partnership: Encourages participation from team members. • Manages Changes: Demonstrates flexibility with changing environments. • Problem Solving: Resolves issues in a professional and timely manner. • Attention to Detail: Follow procedures to ensure entry of information. • Organization: Uses time effectively by prioritizing and planning work activities. • Judgement: Ability to make independent decisions. • Teamwork: Works with others to accomplish objectives and shows support for decisions. • Quality: Sets high standards to ensure quality in work performance. • Accountability: Takes responsibility for adhering to all company policies, procedures, and performance expectations. • Competent in HIPAA, OSHA, and EMTALA regulations
Physical Demands
• Ability to climb, stoop, kneel, reach, stand, walk, pull, push, lift, and able to exert up to 40 pounds of force occasionally and/or up to 10 pounds of force constantly to move objects. • Moderate physical activity performing somewhat strenuous daily activities of a clinical/ clerical nature. • The physical demands for this position include: adequate vision, hearing, and repetitive motions. • Substantial movements of the wrist, hands, and/ or fingers in a repetitive manner. • Use of feet and legs and/ or hands and arms in a repetitive manner. • Bending legs downward and forward by bending leg and spine. • Standing, particularly for sustained periods of time. • Raising objects from a lower to higher position or moving objects horizontally from position to position. • Using upper extremities to exert force in order to draw, drag, haul or tug objects in a sustained motion.
Work Environment
• Well lighted, heated and/or air-conditioned indoor clinical setting with adequate ventilation. • Clean environment to promote safe patient care
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