Director of Case Management

Responsibilities

Mentors and oversees the work of Social Workers and Case Managers. Directs and provides for the discharge planning of patients to ensure continuity of care and discharge to the least restrictive setting. Ensure compliance with Medicare, Medicaid and managed care guidelines for utilization management and discharge planning.

Identifies "high risk" patients in order to provide social work services and complex discharge planning needs. Participates in Interdisciplinary Discharge Planning Rounds to assess discharge planning needs, identify problems and communicate on-going interventions. Supports/assists patients' families in palliative care/ethics discussions/considerations.

Educates patients and/or families about discharge planning, patient needs, as well as availability and eligibility criteria for programs/services benefits to meet those needs. Ensures Social Workers are completing a PASRR Level 1 screen and faxes to appropriate division for acceptance. Ensures Social Workers are completing a EARC-PAS screen and faxes to appropriate agency.

Ensure compliance with Medicare, Medicaid and managed care guidelines for utilization management and discharge planning. Creatively negotiates, coordinates, and advocates community based services (DYFS, APS, Office of Public Guardian, DDD, etc.) to assure continuation of care and special services appropriate to the age of patients and needs identified.

Maintains current community information and establishes community liaison relationships to maintain an open and efficient referral system and ensure better service delivery to patients and families. Documents all assessments, reassessments and interventions to enhance multidisciplinary communications, as well as, to meet all regulatory and reimbursement standards.

Maintains appropriate case folders, resource files and statistical reports to facilitate monitoring and evaluations. When deficiencies are identified assists in initiating corrective actions. Helps the physician advisor in preparation of the Denial P2P and first level of appeals. Monitors discharge planning delays to identify and report trends for performance improvement and Identifies opportunities for process improvement in patient care delivery, patient safety, and in departmental work process through recognizing, reporting, and resolving barriers to patient throughout.

EDUCATION

• EXPERIENCE REQUIREMENTS Master's Degree in Social Work from a professional school accredited by the Council on Social Work. Minimum 3 years current relevant social work experience. Current NJ Social Worker license: LSW (Licensed Social Worker) or LCSW (Licensed Clinical Social Worker). Excellent verbal and written communication skills.

Capable of working with multiple tasks simultaneously