Clinical Case Manager - Social Worker
Clinical Case Manager - Social Worker
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Salary Not Disclosed
1 Vacancy
Job Description
Clinical Case Manager Social Worker Inpatient Behavioral Health
Salary: $32/hour $48/hour (Dependent upon experience)
Hours: MonFri. No weekends on oncall.
Location: Albuquerque NM (onsite)
Who we are:
Psychiatric Medical Care is one of the countys largest Behavioral Health Management companies. Why work with PMC Because PMC works for you. At PMC we strive to maintain a culture of kindness and accountability. We embrace diversity and inclusion and provide team member support. We encourage everyone at PMC to have a healthy worklife balance and bring their authentic selves to work every day.
Competitive Benefits:
- Free Dental & Free Vision
- Practically Free Medical Starting As Low As $20/Month
- Matching 401k
- Furthering Education Assistance
- Employee Rewards Assistance & Referral Bonus Program
Essential Duties & Responsibilities
Utilization Review & Case Management
- Conducts reviews of patient admissions and continued hospital stays to ensure medical necessity.
- Identifies patients needing case management through admissions screening chart review and discharge planning meetings.
- Performs case management assessments and collaborates with interdisciplinary teams for discharge planning.
- Provides guidance to hospital staff regarding regulatory requirements reimbursement policies and utilization guidelines.
- Reviews observation admissions twice daily to determine appropriate utilization of services.
- Coordinates with the physician advisor on cases that do not meet acute care criteria.
- Ensures timely documentation and submission of thirdparty payer reviews and medical necessity determinations.
Patient & Staff Education
- Educates patients families and healthcare providers on the medical necessity process and regulatory requirements.
- Assists physicians in ensuring complete documentation of patient severity and required services.
- Clarifies treatment plans and collaborates with attending physicians to support appropriate care decisions.
Discharge Planning & Coordination
- Identifies potential delays in care and refers cases to the appropriate department or physician.
- Ensures referrals are completed for patient discharge needs including home health skilled nursing DME and social services.
- Coordinates incoming patient transfers and facilitates outgoing transfers when appropriate.
- Prepares cases for physician advisor review ensuring proper documentation and clear presentation of concerns.
Regulatory Compliance & Quality Improvement
- Keeps current with regulatory requirements including CMS Medicare Medicaid TJC and other compliance standards.
- Monitors and reports on hospital utilization data to improve efficiency and patient outcomes.
- Supports hospital and department mission and vision through best practices in case management.
Professional Development & Collaboration
- Attends department meetings and completes required education and competency training.
- Collaborates with nursing medical staff and ancillary departments to improve patient care processes.
- Serves as a resource for utilization and medical necessity issues across hospital departments.
Care:
- Provide case management to patients and families.
- Act as a point of contact for referral sources seeking patient admission to the Behavioral Health Unit and navigates accordingly.
- Participate in discharge planning arrange followup care and develop mechanisms for exchanging appropriate information with sources outside the hospital in conjunction with the unit Social Worker.
Compliance:
- Assist with performance improvement activities within the department and participate in performance improvement activities.
- Support the Behavioral Health Unit with insurance verification/precertification/certification necessary for maximized patient reimbursement within the designated hospitals Utilization Management program.
Community:
- Serve as a resource person to healthcare professionals concerning community resources.
- Represent the Behavioral Health Unit at various scheduled events.
- Masters Degree In Social work LCSW preferred or LMSW required
- Two or more years of previous experience in all aspects of social service or nursing with an emphasis on psychiatric work preferred
- Excellent oral and written communication skills required
- Verbal and written ability to give information and present ideas essential in administrative management required
- Leadership ability integrity and initiative required
- Ability to problemsolve effectively and positively handle stress required
- BLS required
- HWC training (will be provided) required
- Basic computer knowledge required
Required Experience:
Manager
Employment Type
Hourly
