Social Worker, MSW - Department of Emergency Medicine

Grand View Health • Sellersville, Bucks County, United States • $200k - $250k / year • 1m ago

The role of the Department of Emergency Medicine (DEM) Social Worker, MSW, is to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum. The DEM Social Worker will assist in identifying patients appropriate for admission, observation or other patient care status. The DEM Social Worker will function as a liaison between attending physicians, physician advisors, local CCRCs, SNFs, PCFs, patients, families and community. The role includes the management of social issues that impact patient classification, discharge from the DEM and ongoing medical management of patient care needs. The DEM Social Worker will assist in identifying physician and staff documentation opportunities to support quality and pay for performance indicators. The goal is to collaborate with patients, families and healthcare providers to promote health and manage illness in a cost effective and quality driven manner.

Essential Functions:

Performs 100% review of anticipated admissions utilizing InterQual criteria to assess for appropriate level of care assignment.
Certifies Medicare admissions and utilizes Code 44 when appropriate.
Coordinates and manages inpatient Medicare Discharge expedited appeal requests from the QIO and patients.
Serves as a resource to patients, physicians, administration and hospital employees regarding issues related to patient classification and reimbursement.
Refers inappropriate Observation or anticipated Admission cases to the Physician Advisor.
Decrease non-emergency utilization and over utilization by patients in the DEM.
Provide real time interventions to prevent delays and ensure compliance and revenue integrity with health care regulations.
Identifies and collects data regarding resource utilization for DEM physicians, management and administration for evaluation and process improvement.
Functions as a resource to the DEM via communication of new information regarding coordination of care, Case Management, managed care and the continuum of care.
Identify tests, procedures and interventions earlier to advance the plan of care.
Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.

Schedule: Every other Saturday and Sunday.