Job Description

JOB SUMMARY: Responsible for case managing patients accessing care through Upper Chesapeake’s Family Birthplace and Special Care Nursery. Performs utilization review and discharge planning for all patients. Works collaboratively with inter-disciplinary team to assess plan of care, monitor progress and make recommendations the safest and most efficient hospitalization is achieved. Orients new team members. Position requires 24-hour accountability for planning, organizing, and directing case management activities. May interact with patients or customers ranging in age from newborn to adult.

**JOB TITLE: Case Manager – Family Birthplace and Special Care Nursery **

JOB TASK LIST

1. Utilization Review:

• Identify and prioritize insurance reviews
• Review appropriateness of admissions
• Assess patient plan of care against established criteria
• Document relevant clinical indicators to establish acute care needs
• Communicate daily concurrent review to payor.
• Document any authorizations obtained

1. Communicate with attending physician regarding patients not meeting acute care criteria. Coordinate change in care plan, additional documentation or discharge orders. Consult with physician advisor as needed.

2. Denials:

• Monitor all “pended” days and attempt resolution with attending physician and/or physician advisor as appropriate.
• Inform Denials NCM of any denials and provide any information needed.

1. Hospital Issued Notices of Noncoverage (HINN) and Condition Code 44 Notice

• Identify patients requiring issuance of HINN or Condition Code 44
• Coordinate with Audit Analyst to ensure documentation is accurate
• Communicate with Physician Advisor, Attending Physician and Director
• Discuss regulations with patient/family

1. Screen all patients to identify needs and prioritize caseload

2. Assess patient/families within the caseload to identify physical, social, psychological, and financial needs. Perform and document psychosocial assessments

3. Discharge Planning:

• Collaborate with patient/family to identify appropriate options
• Coordinate with post acute facilities/vendors to ensure smooth transition to next setting.

1. Rounds:

• Have knowledge of patient plan of care.
• Actively participate in rounds to ensure continuity of care is communicated with other disciplines.

1. Abuse Reporting

• Identify and refer cases
• Collaborate with Harford Co Govt agencies to ensure continuity between UCH and Child Protective Services(CPS).
• Develop education for CRM team members to ensure everyone is aware of signs of abuse and are comfortable with CPS referral process.

1. Maintain accurate timely documentation of actions/services.

2. Identify need for, arrange, and facilitate case management conferences when necessary to advance the coordination of complex cases.

3. Assist with special projects and other duties as assigned.

Qualifications

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

** Education, Experience and Qualifications**

• Master’s degree in Social Work accredited by Council on Social Work Education (CSWE).
• LMSW (Licensed Master Social Worker) licensure from the Maryland Board of Social Work Examiners.
• Minimum one (1) year of related experience is required.

** Knowledge, Skills and Abilities**

Demonstrate skill in a) general social work and/or case management practice areas; b) completing social work functions under supervision, including biopsychosocial assessment, resource coordination, case management, psychoeducation, referral, information gathering, therapy, counseling, mental health diagnosis, consultation, advocacy; c) effective critical thinking d) communications both written and oral; and e) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult).

Ability to a) communicate and collaborate effectively with both internal and external stakeholders (i.e. colleagues, medical staff, liaisons, patient, family); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make decisions consistent with current policies, procedures, and ethical standards while operating under supervision; d) prioritize work assignments and manage time effectively to complete duties; and (e) understand and follow written and verbal instruction.

Adhere to the professional principles and standards of practice consistent with underlying core values of the profession, as outlined by the NASW Code of Ethics.

Work Orientation & Experience: Clinical experience with obstetric, newborn or pediatric population required. Acute care hospital experience preferred. Experience in Case Management or Utilization Management preferred. Basic computer skills required.

Skills & Abilities:

Demonstrate skill in a) clinical case management; b) performing complete biopsychosocial assessments; c) effective critical thinking; d) written and oral communications; and e) age appropriate interpersonal interactions (patients may range from newborn to adult). Demonstrate knowledge of a) case management principles; b) abuse indicators and c) acute care criteria.

Demonstrate ability to a) communicate and collaborate effectively with both internal and external customers (colleagues, Medical Staff, liaisons, and patient/family); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) be available to adapt hours to meet the needs of all customers.

Additional Information

Job Code 7010

All your information will be kept confidential according to EEO guidelines.

Compensation

• Pay Range: $31.99-$53.45
• Other Compensation (if applicable): n/a
• Review the 2024-2025 UMMS Benefits Guide