Responsible for the coordination of care and services for the patient through collaboration with the interdisciplinary team.  Performs utilization management continued stay reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources. Monitors plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, transitions of care, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Promotes communication and collaboration among members of the interdisciplinary team, patients and significant others to ensure that specific patient outcomes are achieved and variances are evaluated and addressed as needed.  Responsible for referral of cases to physician review and follow-up relating to professional review organization correspondence

COVID-19 and Flu Vaccination Requirement: It is required to be vaccinated for COVID-19 and Influenza. Exemption requests based on medical or religious reasons may be submitted, but must be approved for active employment. 

Why UnityPoint Health?

• Culture – At UnityPoint Health, you Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.
• Benefits – Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.
• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.
• Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.
• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work. https://dayinthelife.unitypoint.org

1. Principle Duties and Responsibilities:

1. Maintains and applies current knowledge of Utilization Review Methodology, criteria and regulations governing various payment systems to perform admission and continued stay reviews following pre-established criteria as outlined in the Case Management Scope of Services or by request of third party payers.

1. Maximizes positive financial outcomes for patients and hospital by conducting ongoing chart review to monitor appropriateness of treatment, resource utilization, quality of care. Applies criteria, performs concurrent reviews.  Works with physicians regarding utilization issues and denials as needed.

1. Collaborates with appropriate team members in planning and implementation of strategies to ensure reimbursement optimization through communication with third party payers and documentation.

1. Responsible for initiating PRO reviews and issuing HINNS following appropriate review and confirmation of non-coverage.

2.   Facilitates the coordination of care and services through initial assessment and collaboration with the interdisciplinary team.

1. Assesses patient's clinical and psychosocial needs, identifies risk factors and develops plan based on identified needs.

1. Identifies needed orders, and communicates and collaborates with physician and primary nurse to individualize plan of care to meet patient's needs. Reviews the treatment and discharge plan with physician and other health care team members, patient, and family.

1. Coordinates and facilitates interdisciplinary planning and communication through Care Rounds, Complex Care meetings and consistent communication with others.

1.   Facilitates meetings with patients and significant others to insure their participation in the plan of care.

3. Coordinates and facilitates discharge planning through both initial and ongoing assessment of psychosocial, financial, cultural and family factors.

1. Assists patient/significant others in developing discharge plan consistent with identified needs and assists with patient/family education around those needs.

1. Ensures discharge planning process is implemented in a timely manner and ensures that all disciplines are providing appropriate interventions.  Documents appropriate plans and concurrent status of plans.

1. Researches, suggests, and facilitates appropriate agency/community referrals in collaboration with the interdisciplinary team.

1. Assists patients/families with Advance directives including Power of Attorney for Health Care, guardianship, and health care surrogate when appropriate.

1. Provides short term counseling and crisis intervention to patients/families to provide support, to facilitate adaptation to diagnosis and treatment plan, teach coping skills, or relieve anxiety and/or physical discomfort

1. Assists in constructive evaluation of departmental services through participation in the Quality Improvement projects and implementation of systems to increase effective case management by all members of the health care team.

MINIMUM QUALIFICATIONS:

1. EDUCATION, TRAINING & EXPERIENCE: Master’s Degree in Social Work with three to five years’ experience in hospital, intermediate care or home care setting preferred.  Previous utilization review, case management and/or care coordination experience preferred. MSW required.

1. KNOWLEDGE, ABILITIES & SKILLS: Must have knowledge of Medicare Regulations and familiarity with Professional Review Organization regulations.  Must have thorough knowledge of community resources and agencies,.  Must have excellent communication skills both oral and written including the ability to communicate with physicians, hospital staff, patients, families and community agencies. Requires the ability to negotiate and establish effective working relationships with members of the interdisciplinary health care team. Must demonstrate ability to identify and act upon psychosocial needs and work independently in outcome oriented environment. Good knowledge of computer skills.

1. LICENSES, REGISTRATIONS AND CERTIFICATIONS: Social Work license in Iowa and Illinois required.  (License in second state must be obtained within 30 days of hire.) CPR certification required within 6 weeks of employment