Case Manager

locationsKennestone Hospital time typeFull time How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives. Day (United States of America) Job Summary: Primary liaison between the patient, family, the rehab team, outside agencies and their representatives. The Social Worker/case manager provides information about patient's progress, referrals and educational information and adjustment counseling to patients and their families and coordinates the discharge planning process.Adheres to NASW professional standards, codes of ethics, system and department policies and procedures. Core Responsibilities and Essential Functions: CASE MANAGEMENT Reviews all new admissions in EPIC and paper chart for completeness to assure compliance with insurance, pre-certification and DME requirements. Documents discharge issues in the chart at appropriate intervals for progress findings. Communicates with the team regarding progress and/or insurance issues. Communication with insurance providers to obtain episodic authorization. Coordinates team goals, the interdisciplinary team conference and the family education process to assure a smooth flow of care until discharge. Executes various documents with the patient and family as needed. Care coordination and follow-up with patient, family, team and physicians FINANCIAL RESPONSIBILITY Monitors LOS efficiency and facilitates discharge plan process Enters necessary financial and precert information into CANOPY to ensure timely flow. Works with physician and manager to resolve failed or denied patient approvals. Communicates with insurance companies to assure appropriate coverage and claims management. Works with families to assure appropriate resource identification, access and utilization COMMUNICATION Communicates with AC and physicians to facilitate benefits and pre-cert information on insurance patients, internal and external referrals. Serves as a resource for the interdisciplinary team, regarding insurance compliance issues. Communicates to all stake holders regarding patient progress. Meets with patients, families, team members and outside case managers to review patient progress, prepare for timely discharge and schedules the education process for patients and families.. Compliance Assures authorization for equipment as required by insurance; facilitates discharge prescription assurance. Assures documentation meets regulatory standards Participates in chart audits as requested Works with IRF-PAI Coordinator, physician and interdisciplinary team to assure regulatory and CARF compliance Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct. Required Minimum Education: Associates Nursing or Bachelors Nursing or Masters Social Work Required Minimum License(s) and Certification(s): CCM - Certified Case Manager or LCSW - Lic Clinical Social Worker GA or LMSW - Lic Master Social Worker GA or MSW - Master Social Worker or RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact Required Minimum Experience: Minimum 2 years experience in medical case management inpatient rehab Preferred Required Minimum Skills: Demonstrates skills or experience in case management.Strong computer skills required.Good communication skills both verbal and written.Excellent time management/organizational skills;working knowledge of the precertification process;Working knowledge of medical terminology and basic computer proficiency requiredDemonstrated counseling skills, knowledge of community resources, federal and local guidelines, funding resources;understanding of adult and geriatric development and age appropriate careunderstanding of the effects of illness and disability and the impact on both patient and family. Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. #J-18808-Ljbffr