Acts as the primary liaison between patients, families, and the rehab team to coordinate discharge planning and care. Manages insurance authorizations, financial approvals, and regulatory compliance for inpatient rehabilitation.
Requirements summary
Requires an Associate's degree in Nursing or a Master's degree in Social Work, along with a relevant professional license (e.g., LCSW, LMSW, or RN). A minimum of 2 years of experience in medical case management within an inpatient rehab setting is required.
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Work Shift Day (United States of America) Job Summary: Primary liaison between the patient, family, the rehab team, outside agencies and their representatives.
The Social Worker/case manager provides information about patient's progress, referrals and educational information and adjustment counseling to patients and their families and coordinates the discharge planning process.
Adheres to NASW professional standards, codes of ethics, system and department policies and procedures.
Core Responsibilities and Essential Functions: CASE MANAGEMENT - Reviews all new admissions in EPIC and paper chart for completeness to assure compliance with insurance, pre-certification and DME requirements. - Documents discharge issues in the chart at appropriate intervals for progress findings. - Communicates with the team regarding progress and/or insurance issues. - Communication with insurance providers to obtain episodic authorization. - Coordinates team goals, the interdisciplinary team conference and the family education process to assure a smooth flow of care until discharge. - Executes various documents with the patient and family as needed. - Care coordination and follow-up with patient, family, team and physicians FINANCIAL RESPONSIBILITY - Monitors LOS efficiency and facilitates discharge plan process - Enters necessary financial and precert information into CANOPY to ensure timely flow. - Works with physician and manager to resolve failed or denied patient approvals. - Communicates with insurance companies to assure appropriate coverage and claims management. - Works with families to assure appropriate resource identification, access and utilization COMMUNICATION - Communicates with AC and physicians to facilitate benefits and pre-cert information on insurance patients, internal and external referrals. - Serves as a resource for the interdisciplinary team, regarding insurance compliance issues. - Communicates to all stake holders regarding patient progress. - Meets with patients, families, team members and outside case managers to review patient progress, prepare for timely discharge and schedules the education process for patients and families..
Compliance - Assures authorization for equipment as required by insurance; facilitates discharge prescription assurance. - Assures documentation meets regulatory standards - Participates in chart audits as requested - Works with IRF-PAI Coordinator, physician and interdisciplinary team to assure regulatory and CARF compliance.
Required Minimum Education: Associate's Degree in Nursing or graduate of an accredited CSWE Program Required and Master's Degree in Social Work.
Required Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.
Certified Case Manager or Lic Clinical Social Worker GA or Lic Master Social Worker GA or Master Social Worker or Reg Nurse (Single State) or RN - Multi-state Compact Additional License(s) and Certification(s): Required Minimum Experience: Minimum 2 years experience in medical case management inpatient rehab Preferred Required Minimum Skills: Demonstrates skills or experience in case management.
Strong computer skills required.
Good communication skills both verbal and written.
Excellent time management/organizational skills; working knowledge of the precertification process; Working knowledge of medical terminology and basic computer proficiency required Demonstrated counseling skills, knowledge of community resources, federal and local guidelines, funding resources; understanding of adult and geriatric development and age appropriate care understanding of the effects of illness and disability and the impact on both patient and family.
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Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems.
Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care.
Mission, Vision & Values At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery.
OUR MISSION: To enhance the health and well-being of every person we serve.
OUR VISION: Deliver world-class healthcare to every person, every time.
OUR VALUES: We serve with compassion We pursue excellence We honor every voice Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care.
Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality.
Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.
