This position provides comprehensive care coordination for patients as assigned. This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care.
Manages individual patients across the health care continuum to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Acts in a leadership function with process improvement activities for populations of patients to achieve the optimal clinical, financial, operational, and satisfaction outcomes.
Evaluates the medical necessity and appropriateness of care, optimizing patient outcomes.
Establishes and promotes a collaborative relationship with physicians, payers, and other members of the health care team. Collects and communicates pertinent, timely information to payers and others to fulfill utilization and regulatory requirements.
Acts in a leadership function to collaboratively develop and manage the interdisciplinary patient discharge plan. Effectively communicates the plan across the continuum of care.
Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts into daily practice.
May supervise other staff.
Requires masters degree in social work or related field or equivalent experience.
Requires a proficiency level typically achieved with 5 years clinical experience and as required by state law, a licensure in at least one of the following categories: social work, professional counseling or marriage and family. (Certification requires two years post graduate experience in a mental health setting or equivalent combination of education and documented supervised clinical experience.) Positions providing direct services to substance abuse program patients must also possess board licensure in addictions as required by state.
Must have a working knowledge of care management, hospital and community resources. Must demonstrate critical thinking skills, problem-solving abilities, effective communication skills, and time management skills. Must demonstrate ability to work effectively in an interdisciplinary team format.
Additional related education and/or experience preferred.