0.03FTEThe Case Manager 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.The case manager 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.Forwards assessments and clinical data to payers and external providers to facilitate transitions and paymentHandles caseload of patients as determined by managerCommunicates team conference and POC recommendations to patient and family and to third parties as indicatedAssists 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 LOCFacilitates family training as needed in order to support a safe transition to the next LOCAssesses need for and provides referrals to community resources to support the patient safely in the community settingCoordinates with patient/financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denialsProvides ongoing education to interdisciplinary team on patients insurance benefits and status of LOS approvalRequests 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 teamMonitors and communicates resource utilization with attending physicianIdentifies variances from established benchmarks on cost/outcome/LOS and notify physician and teamObtains authorization as required from payer for any special services or proceduresCase Managers in pediatrics assist with managing referrals for IRF and outpatient services as well as assists with referral development objectivesCase Managers in Pediatrics facilitate return to school after discharge and home/hospital tutoring
