Case Manager Social Worker
2 days ago
At Northwestern Medicine, we are seeking a skilled Case Manager Social Worker to join our team. As a Case Manager Social Worker, you will play a critical role in ensuring the smooth transition of patients from admission to discharge.
Responsibilities:- Act as the primary liaison between the interdisciplinary team and the patient/caregiver, educating them on the continuum of care and facilitating discharge coordination.
- Follow patients from admission to discharge, communicating with external payers on their behalf.
- Work in partnership with attending physicians to closely monitor utilization and length of stay.
- Collaborate with patients and caregivers to plan and facilitate timely and appropriate discharge plans.
- Forward assessments and clinical data to payers and external providers to facilitate transitions and payment.
- Manage a caseload of patients as determined by manager, communicating team conference and POC recommendations to patients and families as indicated.
- Assist with facilitation of team conferences to ensure patients continue to meet LOC criteria and are progressing toward discharge goals in conjunction with the interdisciplinary team.
- Work with the interdisciplinary team to ensure procurement of discharge needs for patients in terms of DME, clinical services, and ongoing care to support a safe transition to an appropriate LOC.
- Facilitate family training as needed to support a safe transition to the next LOC.
- Assess the need for and provide referrals to community resources to support patients safely in the community setting.
- Coordinate with patient/financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denials.
- Provide ongoing education to the interdisciplinary team on patients' insurance benefits and status of LOS approval.
- Request authorization for continued stay from payers as recommended by the interdisciplinary team through concurrent review process. Coordinate appeals on any concurrent denials of requests for continued stay.
- Review patients' progress and medical necessity for continued stay against protocol and benchmarks, communicating with attending physicians and the team.
- Monitor and communicate resource utilization with attending physicians.
- Identify variances from established benchmarks on cost/outcome/LOS and notify physicians and the team.
- Obtain authorization as required from payers for any special services or procedures.
- Master's Degree in Social Work with current LSW or LCSW license in the state of Illinois.
We are an affirmative action/equal opportunity employer and do not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation, or any other protected status.
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