Be inspired. Be rewarded. Belong. At Emory Healthcare.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship, development, and leadership programs...and more!

Assesses, implements, coordinates, and monitors options and services to meet health needs of patients using communication and available resources to promote quality, cost effective outcomes. Validates appropriateness of inpatient rehabilitation hospital admissions according to nationally recognized standards. Reviews inpatient and observation cases for compliance with the Utilization Review Plan filed with the State of Georgia. Takes appropriate action to comply with third party payor requirements. Knowledgeable in state and federal regulatory requirements, I.e., Medicaid, Medicare. Provides emotional support to patients.

Reviews each hospital admission in accordance with nationally recognized criteria and department policies to determine the medical necessity of admission and appropriate length of stay (LOS). Intervenes as required with physicians and Interdisciplinary Patient Care Teams to facilitate achievement of targeted LOS. Issues and administers notices of non-coverage and potential liability to clients in accordance with predetermined regulations, policies and procedures. Facilitates MD to MD reviews as needed. Maintains an effective flow of information between nursing units, physicians, Medical Records, Business Office and third-party payors to facilitate appropriate LOS and to ensure appropriate reimbursement and coverage.

Maintains a cooperative relationship with professionals, physicians and community agency representatives. Efficiently covers for colleagues as requested and thoroughly conveys patient care status and plan of care in order to assure continuity and uninterrupted service upon colleagues return. Thoroughly prepares covering colleagues in advance of planned absences. Demonstrates the skills necessary to nurture team building and growth in establishing and maintaining a cooperative relationship with professionals, physicians, patients, family members and community agency representatives. Assess patients and members of their support system in order to identify potential needs, to determine appropriate level of care for discharge planning purposes and to identify necessary interventions. Evaluates family, home environment and financial situation in order to develop safe and viable plan of care. Provides patient and family education regarding discharge planning and community resources. Provides supportive counseling for patients, families and significant others who are experiencing anxiety or stress due to illness, injury or physical limitations. Evaluates, coordinates and acts in accordance with current laws and hospital policies in reporting targeted populations (suspected child/disabled adult/elder abuse or neglect). Collects and records required Utilization Management information for appropriate management of the patients in the rehabilitation units.

Acknowledges and appropriately prioritizes referrals from interdisciplinary team members, patients, and families with initial chart documentation entered within 24 hours of receipt of consult except for holidays and weekends. Attends and actively participates in meetings in order to screen for high risk patients, obtain and share information, identify appropriate length of stay. Maintains focus on the provision of quality service in a rapid and efficient manner in order to transition patients to the appropriate level of care within the time frame of the target length of stay. Updates the clinical team regarding discharge destination, and date and time of anticipated discharge. Collaborates with insurance case managers and community care providers, and initiates referrals to appropriate community resources. Maintains a thorough working knowledge of Medicare, Medicaid and private payor regulations and processes and a broad knowledge of resources and options for patients available within all levels of care; facilitates efficient access and movement of patient across levels of care, and coordinates inter-facility transfer of patients to appropriate level of care. Respects the confidentiality of all patient information and conforms to hospital/departmental policies. Acts as a responsible steward of departments and patient/family's

patient care funds.

Works with manager to formulate plan for professional development. Attends educational in-services as appropriate. Participates in professional activities and organizations to maintain knowledge of current trends, practices and developments.

Maintains accurate, legible, confidential documents and records pertaining to medical reviews in accordance with departmental policy. Completes all necessary paperwork and computer documentation in order to assure accurate reimbursement to the organization and compliance with regulatory requirements. Completes additional assignments/projects as directed by department leaders.

Supports and participates in multidisciplinary patient/family education and care planning with the entire healthcare team. Develops educational and resource materials and programs to meet the needs of assigned patient population, and to meet the education needs of the medical team and peers. In collaboration with supervisor, pursues professional development opportunities through local, regional and national forums. Acts as a professional resource for colleagues within and outside the organization Provides education to the community as needed. 

MINIMUM QUALIFICATIONS:

• Masters in Social Work from an accredited Institution.
• At least 1 year experience preferred, experience in an Acute Care setting preferred.
• Knowledge of software applications.
• ACM, CCM preferred.

Supporting a diverse, equitable and inclusive culture.  Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.  Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

Accommodations: EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.”  

Physical Requirements: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. 
 
Environmental Factors: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.