Care Manager / Social Work - Waterville OR Pittsfield, ME
Company: UnitedHealth Group
Location: Albion
Posted on: September 21, 2023
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Job Description:
$10,000 Sign On Bonus For External Candidates
Opportunities at Northern Light Health, in strategic partnership
with Optum. Whether you are looking for a role in a clinical
setting or supporting those who provide care, we have opportunities
for you to make a difference in the lives of those we serve. As a
statewide health care system in Maine, we work to personalize and
streamline health care for our communities. If the place for you is
at a large medical center, a rural community practice or home care,
you will find it here. Join our compassionate culture, enjoy
meaningful benefits and discover the meaning behind: Caring.
Connecting. Growing together.
The Care Manager/Social Worker, as part of a multidisciplinary
team, including the patient/family, physicians, nurse's therapists,
and payors ensures the patient's progress in the acute episode of
care through post discharge and is quality driven while being
efficient and cost effective. The incumbent interacts with
patients, family members, healthcare professionals, and community
and state agencies in this effort.
The Care Manager/Social Worker serves as a liaison between the
hospital and community agencies or facilities for the exchange of
clinical and referral information. The Care Manager/Social Worker
reviews high risk patients from a psychosocial and medical
perspective and assesses the psychological needs of patients and
families and provides information, support, counseling, care
management, and referrals to appropriate resources.
The MSW Care Manager and RN Care Manager work collaboratively to
ensure patient needs are met and care delivery is coordinated
across the continuum. The expertise of the MSW is sought to resolve
psychosocial patient care issues and to develop complex patient
transition/discharge plan as needed.
The Care Manager/Social Worker is responsible for maintaining
hospital compliance with the Quality Improvement Organization (QIO)
series provides case review to third party payers and assisting in
the denial and appeals process as well as assessing quality, levels
of care and identifying and reporting potential risk management
issues. The incumbent performs duties and tasks in accordance with
performance standards established for the job. The incumbent may
have access to highly confidential patient, employee and/or
proprietary information, and must handle & protect the information
in accordance with hospital & system policies, HIPAA requirements
and the highest level of ethical standards. The incumbent is
responsible for reporting all security events, potential events, or
other security risks to the organization.
This position is full-time, Monday - Friday. Employees are required
to work our normal business hours of 8:00am - 5:00pm. It may be
necessary, given the business need, to work occasional overtime or
weekends. Our offices is located at Inland Hospital 200 Kennedy
Memorial Dr, Waterville, ME 04901 and Sebasticook Valley Hospital
(SVH) 447 N Main St, Pittsfield, ME 04967. You will work 20hours a
week in Waterville, ME and 20hours a week in Pittsfield, ME.
Primary Responsibilities:--
Reviews patient charts
Provides assessment, social services, and counseling to patients
and their families in relation to social, psychological, financial,
and family situations which will allow timely discharge
facilitation.
Obtains, interprets, and communicates necessary information
regarding patients and families, including social history
information, to staff and physicians.
Performs clinical assessments and initiates interventions on
assigned patients as appropriate to ensure optimal patient
outcomes. Should be done through collaboration with
multidisciplinary team.
Attends Focus of Care rounds per unit schedule.
Meets with patients and families to provide psychosocial support as
needed.
Facilitates and coordinates details of placement and actual
discharge to appropriate agencies.
Discusses nursing, psychosocial needs and medical information with
facilities.
Provides and updates referrals to facilities through
online/software discharge planning tools.
Reviews and completes all appropriate information accompanying
patient facility.
Acts as a liaison between hospital and those facilities should
discharged patients be hospitalized. Arranges time and mode of
transportation to facilities for patients.
Facilitates and coordinates individualized discharge plan.
Arranges and participates in care conferences with unit staff, home
care staff, facility staff, patients and/or families.
Provides adequate avenues of communication through on-going
documentation in eDischarge and telephone/verbal reporting or
electronic tools.
Coordinates and communicates with home care agencies regarding
expected standards of care for requested specific treatments and
psychosocial needs.
Identifies and provides information on requested procedure,
medicines and psychosocial needs.
Assists patients and families with obtaining community assistance
by referral to proper resources.
Serves as a resource to physician and hospital personnel regarding
available agency, facility, and community services to assist in
discharge planning.
Develops and maintains good working relationships with outside
community health and social agencies. Reaches out to the community
to develop new resources for meeting patient needs.
Discusses specific continuing care needs with physicians and
hospital personnel on a regular basis.
Arranges and participates in care conference.
Discusses on-going continuing care needs of patients with
multidisciplinary team daily.
Completes appropriate State of Maine forms.
Monitors the completion of the MED by Goold for all first time
Medicaid transfers to nursing facilities.
Alerts Goold to complete The MED on Medicaid patients with expired
bed holds.
Alerts Goold to complete The MED on Medicaid patients with need for
community programs.
Ensures adherence to Quality Standards.
Participates in departmental and hospital Quality Improvement
programs.
Provides adequate documentation of initial assessments, on-going
writing of progress notes and reviewing of all referrals for
accuracy and content prior to discharge.
Accepts responsibility for further development of professional
learning and growth.
Medical Record Review:
Conducts inpatient admission reviews for appropriateness of
setting.
Conducts on-going case review for continued stay criteria and
enters data.
Monitors quality of care using predetermined criteria.
Reports potential risk management issues as through medical record
review.
Enters data as requested to support Quality Improvement initiatives
in Midas.
Reporting:
Consults with Physician Advisor and leadership as necessary to
resolve barriers through appropriate administrative and medical
channels.
Computer Skills:
Identifies patients and families in need of social work
services
Performs high-risk screenings
Responds to patient and family request for case work services.
Provides psychosocial assessments of the patients and families in
relation to the crises of acute and chronic illness.
Consult with patient to determine psychosocial concerns and
needs.
Meets with family for their input around concerns and needs in
relationship to the illness.
Reviews medical charts/nurse assessment forms for further insight
into patient's needs.
Develops and implements appropriate treatment plans and
interventions.
Utilizes crisis interventions to mobilize resources in response to
crises.
Counsels and supports individual, families to help adjust and cope
with illness.
Make referrals to appropriate community resources.
Refers patient and families to appropriate resources regarding
insurance issues.
Works as in advocate within and without the hospital.
Assumes responsibility for own professional growth and on-going
education
Seeks opportunities to meet learning needs through workshops and
literature.
Maintains knowledge of necessary QIO transmittal services to
facilitate appropriate level of care and denial activities within
the hospital.
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.--Required
Qualifications:--
Licensed Social Worker
6+ months of clinical experience as a Social Worker in an extended
care facility and / or community healthcare environment
1+ years of experience with insurance coverage and / or various
government programs
Ability to travel up to 50% of the time
Ability to work full-time between 8:00am - 5:00pm including the
flexibility to work occasional overtime given the business need.
You will work 20hours a week in Waterville, ME and 20hours a week
in Pittsfield, ME.
Flu vaccination are an essential job function of this role.
Candidates located in states that mandate booster doses must also
comply with those state requirements. UnitedHealth Group will
adhere to all federal, state and local regulations as well as all
client requirements and will obtain necessary proof of vaccination,
and boosters when applicable, prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation.
Preferred Qualifications:--
Soft Skills:
Excellent written and oral skills
Identifies challenges and problem solves with key stakeholders to
reach solutions that meet the needs of customers
Drive to consistently meet objectives and maintain focus
Self-directed with proven organizational skills and ability to be
flexible and work with ambiguity
Ability to execute on identified deliverables either directly or
influencing and driving internal and external partners
Resourcefulness-ability to procure detailed data and
information
Proven ability to boil down extensive research findings into
relevant insights
Detail-oriented and ability to identify potential risk or problems
and recommend path to resolution
Ability to interact one-on-one and consult with all levels of
leadership
**PLEASE NOTE** The sign on bonus is only available to external
candidates. Candidates who are currently working for a UnitedHealth
Group, UnitedHealthcare or related entity in a full time, part
time, or per diem basis ("Internal Candidates") are not eligible to
receive a sign on bonus.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.--
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Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity / Affirmative Action employer, and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law.--
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.--
#RPO #RED--
Keywords: UnitedHealth Group, New England , Care Manager / Social Work - Waterville OR Pittsfield, ME, Healthcare , Albion, Northeast
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