Northwestern Medicine
Case Manager Social Worker - Full Time Days
Northwestern Medicine, Mchenry, Illinois, United States, 60050
Case Manager – MJ Social Worker
The Case Manager – MJ Social Worker reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
Responsibilities
Serves as primary liaison between the interdisciplinary team and the patient/caregiver, educates patient/caregiver on the continuum of care and facilitates discharge coordination.
Follows the patients from admission to discharge.
Communicates to external payers on behalf of the patient.
Acts in partnership with the attending physician to closely monitor utilization and LOS.
Works with the patient/caregiver to plan and facilitate a timely and appropriate discharge plan.
Handles caseload of patients as determined by manager
Forwards assessments and clinical data to payers and external providers to facilitate transitions and payment
Communicates team conference and POC recommendations to patient and family and to third parties as indicated
Assists with facilitation of team conference to ensure that patient continues to meet LOC criteria and is progressing toward discharge goals in conjunction with interdisciplinary team.
Works with interdisciplinary team on ensuring procurement of discharge needs for patient in terms of DME, clinical services and ongoing care to support a safe transition to an appropriate LOC
Facilitates family training as needed in order to support a safe transition to the next LOC
Assesses need for and provides referrals to community resources to support the patient safely in the community setting
Coordinates with patient/financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denials
Provides ongoing education to interdisciplinary team on patient’s insurance benefits and status of LOS approval
Requests authorization for continued stay from payers as recommended by interdisciplinary team through concurrent review process. Coordinates appeals on any concurrent denials of requests for continued stay.
Reviews patients progress and medical necessity for continued stay against protocol and benchmarks and communicates with attending physician and team
Monitors and communicates resource utilization with attending physician
Identifies variances from established benchmarks on cost/outcome/LOS and notify physician and team
Obtains authorization as required from payer for any special services or procedures
Case Managers in pediatrics assist with managing referrals for IRF and outpatient services as well as assists with referral development objectives
Case Managers in Pediatrics facilitate return to school after discharge and home/hospital tutoring
Qualifications Required
Master’s Degree in Social Work with current LSW or LCSW license in the state of Illinois.
Preferred
Previous experience with Case Management and/or Discharge Planning in a hospital setting
Previous experience in a rehabilitation setting
Equal Opportunity Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background Check Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case‑by‑case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well‑being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign‑on Bonus Eligibility Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign‑on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
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Responsibilities
Serves as primary liaison between the interdisciplinary team and the patient/caregiver, educates patient/caregiver on the continuum of care and facilitates discharge coordination.
Follows the patients from admission to discharge.
Communicates to external payers on behalf of the patient.
Acts in partnership with the attending physician to closely monitor utilization and LOS.
Works with the patient/caregiver to plan and facilitate a timely and appropriate discharge plan.
Handles caseload of patients as determined by manager
Forwards assessments and clinical data to payers and external providers to facilitate transitions and payment
Communicates team conference and POC recommendations to patient and family and to third parties as indicated
Assists with facilitation of team conference to ensure that patient continues to meet LOC criteria and is progressing toward discharge goals in conjunction with interdisciplinary team.
Works with interdisciplinary team on ensuring procurement of discharge needs for patient in terms of DME, clinical services and ongoing care to support a safe transition to an appropriate LOC
Facilitates family training as needed in order to support a safe transition to the next LOC
Assesses need for and provides referrals to community resources to support the patient safely in the community setting
Coordinates with patient/financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denials
Provides ongoing education to interdisciplinary team on patient’s insurance benefits and status of LOS approval
Requests authorization for continued stay from payers as recommended by interdisciplinary team through concurrent review process. Coordinates appeals on any concurrent denials of requests for continued stay.
Reviews patients progress and medical necessity for continued stay against protocol and benchmarks and communicates with attending physician and team
Monitors and communicates resource utilization with attending physician
Identifies variances from established benchmarks on cost/outcome/LOS and notify physician and team
Obtains authorization as required from payer for any special services or procedures
Case Managers in pediatrics assist with managing referrals for IRF and outpatient services as well as assists with referral development objectives
Case Managers in Pediatrics facilitate return to school after discharge and home/hospital tutoring
Qualifications Required
Master’s Degree in Social Work with current LSW or LCSW license in the state of Illinois.
Preferred
Previous experience with Case Management and/or Discharge Planning in a hospital setting
Previous experience in a rehabilitation setting
Equal Opportunity Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background Check Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case‑by‑case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well‑being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign‑on Bonus Eligibility Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign‑on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
#J-18808-Ljbffr