Social Work Specialist
7 days ago
Montefiore Medical Center is seeking a highly skilled and compassionate Social Work Specialist to join our team. As a key member of our healthcare team, you will play a vital role in ensuring the optimal utilization of resources, delivery of quality patient care, and compliance with regulatory requirements.
Key Responsibilities- Coordinate the continuum of medical care services for patients to ensure seamless transitions and optimal outcomes.
- Determine the appropriateness of patient care services, prepare clinical appeals for third-party denials, and collect and interpret data for utilization, compliance, and quality improvement initiatives.
- Collaborate with interdisciplinary teams to develop and implement patient-centered care plans.
- Utilize analytical skills to identify trends and areas for improvement, and develop strategies to address these issues.
- Develop and maintain strong relationships with patients, families, and healthcare providers to ensure effective communication and coordination of care.
- Stay up-to-date with federal, state, and commercial regulations related to utilization management, discharge planning, and associated processes.
- Participate in quality improvement initiatives and contribute to the development of policies and procedures to ensure compliance with regulatory requirements.
- Bachelor's degree in Social Work or a related field required; Master's degree preferred.
- Current licensure as a Registered Nurse (RN) in New York State required.
- PRI assessor number required prior to end of 3-month probationary period.
- 3-5 years of recent acute care clinical experience preferred.
- Experience in utilization management and case management preferred.
- Certification in Utilization Review or Case Management preferred.
- Excellent analytical, problem-solving, and communication skills.
- Demonstrated knowledge of quality improvement tools and techniques.
- Demonstrated knowledge of utilization and case management principles.
- Experience in the application of utilization management decision support criteria preferred.
- Computer skills, including data entry, word processing, and electronic messaging.
- Experience in the use of Windows-based software applications.
- Experience in the use of an electronic clinical information system preferred.
- Excellent interpersonal and teamwork skills.
- Expert clinical knowledge of disease processes to identify care needs.
- Understanding of the healthcare delivery system and its sites of care, delivery models, and the roles of various providers and healthcare professionals.
- Experience in interpreting and applying benefit coverage rules and assessing coordination of benefits guidelines and managed care regulations required.
- A competitive salary and benefits package.
- A dynamic and supportive work environment.
- Opportunities for professional growth and development.
- A commitment to diversity, equity, and inclusion.
Montefiore Medical Center is one of the nation's largest academic medical centers, affiliated with Albert Einstein College of Medicine. We are a growing organization and one of New York's top employers. Our mission is to provide excellent care to all, and we are committed to furthering our reputation as a leader in clinical care, healthcare research, education, and social commitment.
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