Post Acute Care Social Worker - eviCore- Remote

Utilizing telephonic outreach, the Social Worker performs clinical and operational processes related to Post-Acute Care services, including but not limited to long-term acute care, skilled nursing, inpatient rehab, home health care, DME, care management, and utilization review.

The social worker addresses health equity and social determinants of health concerns and proactively addresses top admission-driving diagnoses that may impede the patient's ability to adhere to their medical care plan by leveraging knowledge of plan benefits and community resources.

The Social worker may support various regions and provide cross-coverage between regions.

This varies by market and panel size.

Social worker must have the ability to work independently and effectively communicate to internal and external customers.

In addition to supporting our patients, the social workers support other disciplines and provide consults, training, and education as appropriate.

Key Responsibilities


* Interfaces with the care team to facilitate effective communication, referrals, and development of an integrated care plan


* Collaborates with the care team to achieve identified patient outcomes


* Coordinates the treatment plan to accommodate the health service needs of the member, incorporating community resources when available


* Attends and actively participates in care team meetings


* Balances business needs with patient advocacy


* Builds solid working relationships with internal team members, matrix partners, key functional areas, customers and providers


* Provides decision support where multiple treatment options are available


* Identifies high-risk/high-cost patients for social service intervention.


* Initiates contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment plan.


* Other Duties as assigned.

Job Related Skills:


* Excellent time management, organizational, research, analytical, negotiation, communication (oral and written) and interpersonal skills


* Strong skills in the following areas: teamwork, assessment complex issues, ability to recommend changes and resolve problems through effective decision making


* Knowledge of managed care and utilization review requirements and procedures.


* Ability to work within changing business environment and balance business needs with patient advocacy


* Management of local community based resources that may meet needs of patients


* Strong personal computer skills, EMR experience, MS word, Excel, Outlook experience, and Internet research desired

Qualifications


* Must have an active and unrestricted LMSW or LCSW in state of residence.


* Three more years' experience in a Home health, SNF, and/or rehab experience preferred


* Preferred Qualifications (Experience)


* Clinical experience in acute care, a clinical setting, or in case management including experience/expertise in one...