CASE MANAGER II - SW (LCSW) - HMTS - HMG ADMINISTRATION

Pediatric Care is Required

 

Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination and addressing the psycho social needs of the patient.  

 

The goal of the Care Manager, Social Worker (MSW/LCSW) is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources.  The Care Manager Social Worker utilizes the following processes to meet the patient’s individual healthcare needs:  assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care.  The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission vision and core values of the Care Management team, as well as the organization. 

 

Essential Functions:

Care Manager – Social Worker (MSW/LCSW)

  • Assessment: The Care Manager Social Worker will collect in-depth information about a persons’ situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient’s needs. The Care Manager Social Worker will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient’s well-being.  This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations. 
  • Planning: The Care Manager Social Worker will identify specific objectives, goals and actions, as identified during the
  • assessment process. Acting as a patient advocate the Care Manager Social Worker will collaborate with the physician, the patient & family, and members of the healthcare team, to formulate a shared plan of care. Goals and time frames for goals, appropriate to the patient, will be set.
  • Implementation:  Executes specific interventions that will lead to accomplishing the goals and timeframes of the shared plan of care, Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process.
    The Care Manager Social Worker will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.
  • Coordination:  Organizes, coordinates, provides, modifies or obtains appropriate authorizations, utilizing appropriate utilization review and evidence of coverage guidelines, to accomplish the patient’s goals. Initiates and communicates with the patient and family, physicians, healthcare members, and community and payor representatives. Facilitates continuity of care throughout all access points involving Health Plan, discharge planners, physicians and other appropriate staff.
  • Monitoring:  Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and services provided.   Manages a caseload of high risk, complex needs and/or catastrophic patients.  Participates in data collection to understand trends and opportunity for process improvements.
  •  Evaluation:  At appropriate and repeated intervals, assesses and reassesses the patients’ progress. If   progress is static or regressive, determines the reason and encourages the appropriate interventions to obtain optimal outcomes. The Care Manager Social Worker will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.
  • Communication:   Communicates both verbally and electronically with the patient and the healthcare team. Appropriately documents the plan of care, outcomes, statistical reporting, logs, and files abiding to departmental, legal and regulatory requirements. 
  •  

    Additional Responsibilities: 

  • Understand the requirements for approval by payer.  In conjunction with the healthcare team, evaluate medically necessary services, be able to acquire and analyze the cost of care. Understand the various health care delivery systems and payer plan contracts; be able to demonstrate appropriate resource management.
  • Offer counseling or referral to counseling and appropriate resources for elder abuse, domestic violence, statutory rape,
  • and child abuse.  Initiate and complete all state mandated documentation, both verbal and written within the appropriate time frame.
  • Assists in the identification of learning needs of the healthcare team regarding case management and social services and participate in development and implementation of in-services and resource materials to promote education.
  • Provide counseling to patients and families to help cope with biopsychosocial issues related to and/or impacting the patient's illness and functioning.
  • Participates in multidisciplinary rounds--formal and/or informal.
  • Assists in the referral and investigation of quality and risk management issues.  Demonstrates understanding of patient right/confidentiality and legal and ethical issues pertaining to them.
  • Performs all other duties as assigned.
  •  

    Age-Related Competencies

  • Human development knowledge/skills:
  • Demonstrates the knowledge and skills necessary to coordinate care appropriate to the age of the patients served including knowledge of the principles of growth and development and psychosocial characteristics and interventions for any age member of our network.
  • Age-specific patient needs that employee is required to understand and meet:
  • Demonstrates the ability to gather age appropriate data about the member’s status in order to identify age-specific needs and coordinate the care needed.
  • Additional requirements:

  • Demonstrates age appropriate communication skills for the patient population served.
  • Demonstrates knowledge of age-specific community resources.

 

Education, Training and Experience

 

 

Care Manager – Clinical Social Worker (MSW)

Required:

  • Master’s Degree in Social Work (MSW) from an accredited school
  • Minimum one (1) year of clinical experience in a medical group, affiliated model, hospital or medical office/clinic setting

 

Care Manager – Clinical Social Worker (LCSW)

Required:

  • Licensed Clinical Social Worker (LCSW), in good standing, in the State of California
  • Master’s Degree in Social Work (MSW) from an accredited school
  • Minimum one (1) year of clinical experience in a medical group, affiliated model, hospital or medical office/clinic setting

 

Preferred:

  • Three (3) years’ experience in case management highly desirable.
  • Psychiatric chemical dependency treatment

 

 Skills or Other Qualifications

 

 

Required:

  • Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system required.
  • Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum.
  • Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way.
  • Excellent interpersonal, verbal and written communication skills.
  • Ability to problem-solve.
  • Ability to access and evaluate community resources to meet patient’s needs.
  • Ability to handle multiple tasks at a time and remain organized.
  • Ability to work autonomously but demonstrates the ability to work collaboratively on a team.
  • Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities.
  • Excellent computer and IT system knowledge.
  • Possesses the knowledge and skills necessary to communicate with third party payers.
  • Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner.
  • When driving is required, a Valid California Driver’s License and automobile insurance for employee-owned vehicles.
  • Ability to travel between Hoag Medical Group Locations and other destinations as needed to fulfill the job requirements.

 

License and Certifications

 

Required:

Case Manager (LCSW)

Licensed Clinical Social Worker (LCSW) in good standing, in the State of California

 

Preferred:

Certification in Case Management (CCM, ACM)

Company
Hoag Hospital Hoag Memorial Hospital Presbyterian
Posted
04/13/2018
Type
Full time
Location
Newport Beach, California 92657, US