Social Worker MSW

Summary

The Master of Social Work (MSW) Case Manager plays a pivotal role in maintaining the quality of care patients receive during medical centerization and post discharge while ensuring the organization is fully reimbursed. The MSW Case Manager (CM) must have a high level of expertise and skill to create highly effective strategies for short term and long term goals in order to prevent readmissions and address unpredictable situations.

MSW CM must be proficient in planning, executing and monitoring effectiveness of the care provided to ensure timely transition through the continuum of care. Educating and consulting with the physician and the health care team to ensure accuracy of medical necessity criteria and to ensure timely and appropriate level of care is achieved. This requires effective skills in conflict resolution, decision making and team building.

The MSW Case Manger practices in accordance with the care management process utilizing tools, standards, models, goals and objectives, and performance improvement concepts. The MSW Case Manager provides pertinent clinical data to outside agencies as needed to assure compliance with their requirements and represents the organization professionally. The ability to analyze, evaluate and distribute resources and educational information to ensure understanding of services to all educational level is key to the role.

The social worker is responsible for assessing the patient's psychosocial-spiritual needs, education and counseling.

• (30%)
  * Provide social work intervention as it relates to hospitalization including crisis management, health care decision making, illness adjustment, ethical/legal concerns, discharge planning, and transitional care needs, child or elder abuse, domestic violence, competency, financial problems, compliances issues, substance abuse, mental illness as well as other psychosocial barriers to maximizing health status.
• (30%)
  * Work with health care team, patient, family and/or significant others to continually transition the patient to the appropriate level/place of care. Advocate, mediate, and negotiate, with an emphasis on self-determination for the patient system, to formulate a cohesive plan for maintaining the patient’s health status, improving social supports, and moving the patient safely into less restrictive, less costly levels of care according to available resources.
• (20%)
  * Collaborate with the physician in competency/capacity determination, obtaining legal guardianship, involuntary psychiatric admission, adoptions, ethical concerns, etc. Complete and disseminate all necessary legal and clinical documentation as needed for resolution.
• (20%)
  * Collaborates with all members of the Care Management Team including physicians, nurses, health information analysts, and others to provide information relating to admission, continued stay, discharge criteria, managed care, federal program regulations, reimbursement fundamentals, and regulatory standards on a daily basis.
• Other duties and responsibilities:
  Complete and document a standard social work psychosocial-spiritual assessment to eliminate barriers to treatment, increase patient/family satisfaction, improve appropriate utilization of resources.
• Serve as the lead in obtaining financial and other resources for patients and families in need.
• Identify the need for and conduct family meetings, with or without the physician, that result in understanding, comfort, decision-making, and other important outcomes.
• Integrate relevant theories of family dynamics, crisis intervention, strengths based, solution focused, and meaning of illness into everyday casework.
• Summarize a patient and family situation concisely, with helpful guidance to non-social work staff members about recommendations for actions to be taken and barriers to discharge.
• On specific units, analyzes the clinical information on admission, concurrently, and retrospectively (per medical necessity criteria/Inter Qual Guidelines) to assure quality care is being provided to the patient, in the appropriate location, on a daily basis.
• Determines the necessity for second-level review and implement process per hospital policy.
• Collaborates with physicians to determine appropriate patient status and successfully negotiates patient status with the payer.
• Facilitates discharge planning for patients i.e. extended care placements, other facility transfers, and home care arrangements in collaboration with the health care team.
• Actively participate in care coordination efforts to successfully identify high-risk factors and respond appropriately so that key information, next steps and avoidable days are captured and documented. Is an active participant in the daily care coordination meetings.
• Accepts accountability for the clinical outcomes that the Utilization Review and Discharge Planning role can facilitate.
• Maintains timely, clear and concise documentation in all required systems.
• Provides pertinent clinical data to designated outside…