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Promotes the achievement of optimal clinical and resource utilization allocation, facilitates appropriate lengths of stay and reimbursement for all hospital admissions in accordance with goals and objectives. Act as a key informational and educational resource liaison for team. Works to develop organizational approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients and families.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master’s Degree in Social Work or related field.
2. LGSW/LCSW/LICSW certification in the state of West Virginia.
EXPERIENCE:
1. Three (3) years of Medical Social work experience.
OR
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelors of Science Degree in Nursing.
2. Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
EXPERIENCE:
1. Three (3) years of registered nursing experience.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Care Management Certification upon hire or obtained within one (1) year of hire.
EXPERIENCE:
1. Two (2) years in an inpatient hospital setting.
2. Two (2) years of Care Management or supervisor experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Oversees the discharge/transition planning executed by the Care Management staff, and audits said activities for accuracy of delivery.
2. Conducts weekly Clinical-Financial meetings to monitor patients with high dollar, high LOS and/or social barriers. Collaborates with multidisciplinary team to problem solve for these cases.
3. Working knowledge of regulatory requirements and insurance coverage/limitations as it relates to care delivery in the acute setting and transitioning to the non-acute setting.
4. Participate in weekly meetings with new employees and Preceptor during orientation phase to evaluate the staff progress and adjust plans accordingly.
5. Demonstrates clinical expertise by serving as a resource and role model for department personnel.
6. Provides guidance on complex high acuity patient assessments and interventions, and intervenes accordingly.
7. Provides timely and comprehensive documentation of interactions with patients/families.
8. Assists departmental executive leadership team in the development of annual competency analysis system requirements and criteria to assure knowledge, skills and attitudes that are necessary to fulfill role expectations in the institution.
9. Provide constructive and timely feedback to Manager on employee performance and management.
10. Supports an environment for innovation, creativity and empowerment with care delivery based on current literature and research.
11. Promotes and contributes positively to intradepartmental and interdepartmental relationships.
12. Serves as role model and promotes within the staff effective communication and conflict resolution skills, reflecting quality service attitudes and keeping consumer satisfaction in mind.
13. Performs monthly compliance audits as directed.
14. Serves on various hospital committees as needed or assigned.
15. Educates hospital staff and physicians to payer regulations and managed care principals to ensure seamless patient care.
16. Fosters the integration of staff and/or students into the healthcare team.
17. Improves and maintains management skills by participating in self-development activities such as seminars, workshops, classes and literature review.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Prolonged walking, standing, or sitting may be required
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Flexible hours to include weekends and holidays.
SKILLS AND ABILITIES:
1. Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and healthcare team colleagues.
2. Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change
3. Demonstrates expert team building skills, problem solving abilities, and conflict resolution strategies
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
UHA University Health Associates
Cost Center:
4403 WVUH CH Pediatrics Care Management
Address:
1 Medical Center DriveMorgantownWest Virginia
WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.
