Social Worker, Msw Job in Salem, Massachusetts US
Social Worker, Msw
Job Description SUMMARY: Coordinates, negotiates, procures and manages resources to support the care of complex patients and to facilitate achievement of quality, cost effective care. Works collaboratively with interdisciplinary staff internal and external to the organization to ensure efficient utilization of health care resource including but not limited to: acute, intermediate and chronic care services, specialty programs and services, utilization of health care personnel and material resource. Participates in quality improvement and evaluation processes related to the management of patient care across the continuum. PRIMARY RESPONIBILITIES: - Coordinates the Health risk Assessment Process - Perform Case management functions for all patients throughout the continuum of care, assuring compliance with NSHS Medical Management Plan and Policies Procedures. - Directs the daily Referral Management process to assure compliance with: Health Plan benefits Criteria used to determine approval or denial of benefit Accurate letter response and distribution Prompt turn-around time for response to providers. - Communicates effectively with representatives or contracted Health Plans to ensure compliance with plan requirements, including the timely provision of required data. - Manages the initial authorization and continued approval of all Home Care services, DME, and respiratory equipment. - Coordinates the weekly RSO Medical Management and monthly Quality Improvement meeting. - Maintains strict patient confidentiality. - Participates in department meeting and Medical Group level meeting as assigned. Qualifications SKILLS/ ABILITIES/ COMPETENCIES REQUIRED: - Standing, walking, bending, stooping, reaching throughout the day. - Occasional lifting of light items (up to 10 pounds) - Moderate periods of time exposed to CRT screen. - Ability to complete daily job responsibilities within normal hours by moving rapidly through the hospital and offices. - Must be able to perform the essential job functions, either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis. - Basic computer skills. - Ability to operate telephone equipment, fax and copy machines. EXPERIENCE REQUIRED: Three or more years of clinical experience in a health care delivery system. Case management, Home Care/Discharge Planning experience is preferred. EDUCATION REQUIRED: Require completion of an accredited Nursing or Social work program. LICENSES, CERTIFICATION and/or REGISTRATION REQUIRED. Current Nursing or Social Work License in the State of Ma is required.