Clinical Social Worker

5 days ago

Wheaton Illinois, United States Northwestern Memorial Healthcare Full time
Job Summary

We are seeking a skilled Case Manager Social Worker to join our team at Northwestern Memorial Healthcare. As a key member of our interdisciplinary team, you will play a vital role in ensuring the seamless transition of patients from admission to discharge.

Responsibilities:
  • Serve as the primary liaison between the interdisciplinary team and patients/caregivers, educating them on the continuum of care and facilitating discharge coordination.
  • Follow patients from admission to discharge, communicating with external payers on their behalf.
  • Act in partnership with attending physicians to closely monitor utilization and length of stay.
  • Work with patients/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.
  • Communicate team conference and POC recommendations to patients and families, as well as third parties 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, including 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.
  • Case Managers in pediatrics assist with managing referrals for IRF and outpatient services, as well as assist with referral development objectives.
  • Case Managers in Pediatrics facilitate return to school after discharge and home/hospital tutoring.
Requirements:

We are seeking a highly skilled and experienced Case Manager Social Worker to join our team. The ideal candidate will have a strong background in social work and case management, with excellent communication and interpersonal skills. The ability to work effectively in a fast-paced environment and prioritize multiple tasks and responsibilities is essential.

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and dedicated individual who is passionate about delivering exceptional patient care, we encourage you to apply for this exciting opportunity.

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