Social Worker Case Manager

Company: CHRISTUS Health
Location: Irving
Posted on: February 20, 2021

Job Description:

Job Description: Description Summary: The Registered Nurse/Social Work Case Manager identifies, evaluates, and provides management of services for patients with complex, catastrophic, long term illness or injury, mental/chemical health, and/or psychosocial issues. To promote quality, effective outcomes throughout the care continuum, the Social Work Case Manager will utilize ongoing social work processes, including critical thinking skills, to administer all facets of the case management process including assessment, planning, development of care plans, implementation of the plan of care, coordination and oversight of services, and evaluation of options and resources. The Social Work Case Manager acts as a member advocate to coordinate and collaborate care with physicians, family, and other providers. The position responsibilities also include an understanding of the impact of psycho social needs resulting in quality, cost-effective care. * Identification of members who will benefit from social work support * Utilization of assessment process to manage member needs, situations, strengths and resources to meet identified goals * Development of a plan of care focused on improving overall well-being, assuring use of evidence-based criteria throughout the continuum of care * Understanding and planning to assure services provided work within the boundaries of the member's plan eligibility * Engagement in ongoing timely professional collaboration and communication with the member, member's family and/or caregivers and healthcare providers according to member's healthcare needs to enhance positive outcomes * Research and refer members to community resources (i.e., food insecurities, child care, mental health/chemical health support) * Provide assistance to support the application of benefits, such as Medicare Advantage, assuring maximization of benefits to support identified needs * Perform ongoing essential case management activities of reassessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of case managed members * Establish and maintain rapport with providers as well as ongoing education of providers concerning appropriate protocol * Facilitate negotiations for out of network care * Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals * Perform telephonic communication with members in case management according to member needs and within Department of Defense contractual time frames * Contact the provider of services and/or case managed member within one (1) business day to confirm initiation of requested items/services considered time sensitive (i.e., within two (2) business days for requested items/services such as routine DME,Home Health, etc.) * Facilitate patient wellness and autonomy through advocacy, communication, education, and identification of service resources * Identification of appropriate providers and facilities, assuring that available resources are being used in a timely and cost effective manner * Maintain quality documentation of collected data, actions taken, and results of actions taken in order to promote continuity of care within governmental and contractual requirements * Collaborate with onsite case managers and telephonic care managers * Identify and present all cases of possible quality deviation, questionable admissions and out of network services to physician for review and recommendation * Acquires data and evaluates necessary medical services for cost containment * Collaborate with all other departments as appropriate and required to facilitate completion of tasks/goals * Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI) * Adhere to URAC standards * Communication, Collaboration, and Coordination with customers, internal and external * Attend monthly departmental staff meetings and/or interdepartmental meetings as appropriate Requirements: * Graduate of an accredited Registered Nursing program, Bachelor Degree preferred; or Graduate of Social Work Program, LCSW required * Self-starter with ability to handle multiple projects at one time. * Demonstrated organizational, time management, prioritization and team work skills * Analytic ability to prepare status reports and document procedures * Excellent communication skills, judgment, initiative, critical thinking and problem solving abilities * Ability to handle and resolve complex issues * Basic knowledge of computer systems * Good typing skills * Excellent customer service skills * Excellent negotiation skills * Minimum three years of diverse clinical experience as a Registered Nurse or Social Worker * Minimum two years case management and/or utilization review experience * Current/Active Texas RN or LCSW Licensure * Certification in Case Management or Chronic Care Professional preferred Work Type

Keywords: CHRISTUS Health, Irving , Social Worker Case Manager, Executive , Irving, Texas