Pediatric ED, Complex Care Manager (LCSW) - Social Work / Outpatient

A Brief Overview
Complex Care Managers are highly skilled, licensed healthcare professionals responsible for maximizing the efficiency and effectiveness of health care interventions necessary for a patient to attain the optimal results from his or her plan of care. They are dedicated to patient and family centered care that values personal self-determination, manage multiple priorities, and engage in creative, compassionate, and ethical problem-solving. As a member of a multidisciplinary health care team, Complex Care Managers perform comprehensive assessments and develop treatment plans which integrate the medical, social, and financial issues that impact individual patients, families, and populations. Complex Care Managers are responsible for working collaboratively with all healthcare team members to develop and implement treatment plans that support the patient-centered plan of care for both individual patients and the service-line. Complex Care Managers act as consultants to the clinical team, service lines, and other departments regarding patient assessment and patient care and participate in program development and quality improvement initiatives. In their role, Complex Care Managers, apply evidence-based guidelines and collaborate with multidisciplinary teams, influence, and direct the delivery and quality of patient care.

Complex Care Managers are assigned to a group of patients by medical specialty, unit, or clinic, and some activities may differ depending on the needs of the population. Major responsibilities include coordinating all facets of a patient's admission/discharge or outpatient visit/follow-up; performing utilization review activities, including review of patient charts for timeliness of services as well as appropriate utilization of services; and ensuring optimum use of resources, service delivery, and compliance with external review agencies' requirements. A health-system case management program has as its primary goal to ensure the most appropriate use of services by patients and, toward that end, to avoid duplication and misuse of medical services, control costs by reducing inefficient services, and improve the effectiveness of care delivery.

This job description covers all classifications for Social Workers within the organization. All Social Workers must meet all elements of the Essential Functions, and Qualifications.

There is a Voluntary professional development program designed to recognize and reward professional excellence in the role of Social Worker. Promotion is determined based on the Social Worker Professional Development Program. Here is a description of the various levels:
Level I: Social Worker
Level II: Advanced Social Worker
Level III: Expert Social Worker

Locations
Stanford Health Care

What you will do

• Advocacy & Education: Patient/Family Self Care Management, Patient/Family Health Management Education, Bioethics Referrals & Management, Physician, Staff & Community Education, Case Management Education & Training, Risk Management Identification & Referral
• Clinical Care Coordination/Facilitation: Plan of Care & Outcomes Management, Patient Care Integration, Resource Management, Patient/Family Care Conferences, Interdisciplinary Care Communication/Coordination, Continuity of Care Planning Management.
• Continuity/Transition Management: Capacity/Access Management & Throughput, Discharge Planning, SNF/Rehab/LTAC/Assisted Living Placement, Board and Care/Attendant Care Placement, Transportation & Travel Arrangements, DME, Home Health/Home Infusion, Mental Health Service Coordination, Hospice
• Dialysis Coordination & Arrangements, Pharmaceutical Authorization/Management, Community Resource Coordination, Advance Directives, Palliative/End-of-Life Care, Health Care Resource Management/ Clinical Cost Efficiency, Financial Assistance/Referrals, Appeals Management, Entitlement Program Coordination, Patient Benefits Coordination: CCS/GHPP/Medicare/Medi-Cal/SSI
• Performance & Outcomes Management: Federal/State/Local Regulatory Agency Compliance, Joint Commission Standards Compliance, Clinical, Documentation Education/Support, Clinical Guidelines/Pathways/Evidenced Based Practice, Organizational Financial Performance/Management, length of Stay, Cost per Case, Denial Management
• Psychosocial Management: Crisis Intervention, Psychosocial Assessment/Functioning, Counseling Support & Referral, Abuse/Neglect Identification & Referral (Partner, Child, Elder), Family Issues Affecting Care, Coping/Emotional Adjustment, Grief/Bereavement Support (Individual & Group), Adoption Resources, Health/Wellness Promotion, Substance Abuse Screening/Resources, Psychiatric Screening/Behavior, Management, Staff Support and Crisis Intervention (Critical Incident Stress Debriefing)
• Research & Practice Development: Clinical Practice Improvements, Evidenced Based Clinical Practice, Social Work Best Practice Standards Development, Social Work Competency Development, Case Management Best Practice Standards Development, Case Management Competency Development
• Utilization Management: Avoidable Delay Identification, Intervention & Tracking, Utilization Review, Medical Necessity Review, Care Plan Progression, Pre-Admission Planning, Third Party Payer Communication, Level of Care Appropriateness Coordination, Admission Status Determination, Clinical Denial Prevention

Education Qualifications

• Master's degree in Social Work from an accredited college or university

Experience Qualifications

• Three (3) years of progressively responsible and directly related work experience

Required Knowledge, Skills and Abilities

• Knowledge of contemporary case management principles and practice methods, including assessment, treatment planning, utilization management, and quality assurance
• Ability to use multiple electronic systems, software programs, and the internet to review and record information
• Knowledge of medical terminology and related levels of care and treatment
• Ability to collaborate across disciplines to provide comprehensive, integrated care.
• Ability to develop and implement educational materials and presentations for all levels of learners.
• Ability to develop appropriate treatment plans, communicates with interdisciplinary teams, and coordinates care.
• Ability to monitor and assure the patient's access to the appropriate level of care; the right health care providers; and the correct setting and services to meet the patient's needs; promote coordination and continuity in patient health care
• Ability to provide age-appropriate assessments, interpretation of data, and delivery of interventions
• Ability to provide appropriate patient care and clinical information when patients are admitted, referred, transferred, or discharged
• Ability to remain knowledgeable regarding available treatments and services
• Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships
• Ability to understand, interpret and apply complex federal and state hospital compliance laws, rules, regulations and guidelines
• Knowledge of financial processes of various private and public funding sources for health care services/procedures
• Knowledge of hospital operations, organization, systems and procedures and laws and regulations pertaining to the operation of hospitals in California
• Knowledge of the full continuum of care available to patients, interrelationships of the care components, and their effective integration

Licenses and Certifications

• LCSW - Lic Clinical Social Worker .

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Base Pay Scale: Generally starting at $60.99 - $80.78 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.