Schedule: Full time
Shift:Day (United States of America)
Address:5101 WILLOW SPRINGS RD
City:LA GRANGE
State:Illinois
Postal Code:60525
Job Description:Monday-Friday 8a-4:30p; Every 6th weekend and holiday rotation - Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.
- Assesses patients' and families' wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.
- Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.
- Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.
- Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
- Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate. • Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.
- Organizes and facilitates patient and family care conferences with the multidisciplinary team. • Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work. • Provides patient and family advocacy, and support patient's choice and patient rights during hospitalization.
- Communicates with Payors patient's needs for authorization for post-acute care as needed.
- Assesses readmitted patients for the patient's and family's perceived reasons for the readmission.
- Other duties as assigned.
Knowledge, Skills, and Abilities:- Excellent interpersonal communication and negotiation skills [Required
- Critical thinking and problem-solving skills [Required]
- Psychosocial assessment skills [Required]
- Customer service skills [Required]
- Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change [Required]
- Effective organizational skills [Required]
- Computer proficiency with Outlook e-mail and electronic medical records [Required]
- Flexible in a complex and changing healthcare environment [Required]
- Understanding of pre-acute and post-acute venues of care and post-acute community resources [Required]
- Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources [Required]
- Strong interview, assessment, and organizational skills [Required]
- Leadership skills [Required]
- Data analysis skills [Required]
- Current working knowledge of discharge planning, utilization management, care management, performance improvement and managed care reimbursement [Preferred]
- Knowledge of state and federal guidelines pertinent to Care Management [Preferred]
- Ability to identify appropriate community resources and to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes [Preferred]
- Knowledge of state and federal guidelines pertinent to care management [Preferred]
Education:Work Experience:- 2+ care management experience [Preferred]
- 2+ social work [Required]
Licenses and Certifications:- State LSW or LCSW [Required]
- Accredited Case Manager (ACM) [Preferred]
- Certified Case Manager (CCM) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/msy4mja2
Pay Range:$25.90 - $52.52
