JOB DESCRIPTION: Coordinates the patient care process for patients with psychiatric diagnoses to enhance efficiency, patient satisfaction, and cost effective outcomes in accordance with the goals, vision, and mission of the hospital. Validates the appropriateness of admissions to appropriate levels of care within Emory Healthare according to nationally recognized standards. Takes appropriate action to comply with third party payor requirements. Provides information/education on appropriate community resources through triage process with individuals and alternate level of care providers. Knowldedgeable in State and Federal Regulatory requirements (i.e. Medicaid, Medicare). Performs other related duties as required. Maintains an effective flow of information with patients, caregivers, interdisciplinary staff and third party payors to facilitate appropriate lengths of stay (LOS) and to ensure appropriate reimbursement and coverage. When appropriate, completes a problem oriented or detailed psychosocial assessment on all patients who are referred for services. Initiates referrals to Social Services as appropriate. Assumes responsibility for identification of impediments, and communicates and/or addresses barriers to timely discharge. Has strong working knowledge of medical and social interventions for patients who are influenced by health impairment. Assumes responsibility for identification and communication of impediments and addresses barriers to timely discharges. Completes a clinical assessment on all patients referred for services using appropriate clinical standards. Identifies and addresses psychosocial factors which may inhibit full participation by the patient in treatment. Collaborates with all individuals, payors, alternate level of care providers and interdisciplinary patient care team members to expedite the patient through the continuum of care. Provides patient and their families with referral information regarding community support services. Collects and records required Utilization Management information for appropriate assessment of need for admission. Maintains accurate and complete productivity and statistical data on each case according to department protocol. Thorough knowledge of Emory electronic Medical Record (EeMR). Uses this data daily to obtain financial and clinical patient information. Knowledge and use of all software packages and reports utilized within the department. Practices leadership in a changing health care environment that enhances collaboration, continuity, and cost-effective services. Notifies Physician Service teams, unit director(s), unit staff, and Continuum of Care Management staff of patient admissions through alpha text paging system and/or telephone calls. Complies with established policies and procedures and implements pertinent changes to the Continuum of Care process as directed. Takes action to achieve annual departmental goals. Maintains professional growth by participating in educational programs and professional organizations and activities to maintain knowledge of current trends, practices and developments. Collects information and maintains accurate, legible, confidential documents and records pertaining to medical reviews. Facilitates the review process by ensuring the timely delivery of materials to the appropriate personnel. Provides information to comply with regulations of third party payors and federal and state regulatory agencies. Serves as a professional resource to Interdisciplinary Patient Care Teams, physicians, and other professionals within the community for the interpretation of external regulations and organizational policies and procedures pertaining to the Continuum of Care process. Communicates nationally recognized criteria as appropriate. Utilizes medical knowledge as an advocate for the patient to provide pertinent information to third party payors. Serves as a resource in clinical pathway development. Participates in the development and implementation of educational training programs, in-services and workshops for students, staff and other clinical and allied health professionals.
MINIMUM QUALIFICATIONS: Current licensure or licensure eligible as a License Master of Social Work or Licensed Clinical Social Worker in the state of Georgia, or current licensure or licensure eligible as a Licensed Professional Counselor or Licensed Associate Professional Counselor. Two years of post-masters experience; medical and/ or mental health experience desirable. Knowledge of standard office software applications.
PHYSICAL REQUIREMENTS (Medium): 20-50 lbs; 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 50 lbs max; Carrying of objects up to 25 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 environment 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.