Clinical Social Worker

Hospital for Special Surgery; New York (NY); On-site; USD 118,000 - 134,000; Full time

Job summary

Hospital for Special Surgery in New York, NY is seeking a case manager with discharge planning experience in acute or home care settings. The role requires two years in case management and an MSW with NY LCSW licensure, along with knowledge of Milliman (MCG) criteria and PRI/screen certification.

This 35-hour weekday schedule includes M-F 8 AM - 4 PM with some weekend coverage, and base compensation in the $118k–$134k range plus benefits.

Qualifications

• Two years experience in case management with discharge planning or equivalent in acute or home care clinical setting.
• Orthopedic nursing experience is preferred.
• Knowledge of Milliman (MCG) criteria.
• PRI/screen certification.

Responsibilities

• Develops/Manages Processes & Systems - Assists with contracts; assists in the negotiation of physician managed care contracts, analytics, and financial modeling.
• Upholds Standards/Expectations of HSS Staff - Coordinates enrollment; coordinates physician enrollment in managed care plans.
• Upholds Standards/Expectations of HSS Staff - Ensures compliance of managed care companies with negotiated contracts.
• Upholds Standards/Expectations of HSS Staff - Resolves payor issues; follows up on payment issues with Insurance Payors.
• Upholds Standards/Expectations of HSS Staff - Acts as liaison between physician offices and Insurance Payors.
• Upholds Standards/Expectations of HSS Staff - Assists with meetings; schedules, coordinates, and documents for PHO meetings.
• Maintains Documentation & Manages Information - Maintains tracking logs for Insurance Payor issues and accountability.
• Upholds Standards/Expectations of HSS Staff - Oversees PHO line; answers inquiries and assists with urgent physician office issues.
• Upholds Standards/Expectations of HSS Staff - Attendance; maintains satisfactory attendance.
• Upholds Standards/Expectations of HSS Staff - Maintains punctuality; reports for duty punctually.
• Upholds Standards/Expectations of HSS Staff - Adjusts to changing situations and work assignments.

Skills

Case management

Discharge planning

Regulatory standards

Milliman criteria

PRI screening

Orthopedic nursing

Education

Masters in Social Work WITH LCSW

Job description

How you move is why we’re here. ®
Now more than ever.

Get back to what you need and love to do.
The possibilities are endless…
Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximizethe abundant opportunities for growth and success.

HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status

Regular Full time

Work Shift

Compensation Range

The base pay scale for this position is $118,311.47 - $134,311.47. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

JOB DESCRIPTION

M - F

8 AM - 4 PM

2 Weekends per Quarter OR as needed

35 hours

YEARS OF EXPERIENCE REQUIRED
Two years experience in case management with discharge planning or equivalent in acute or home care clinical setting.

YEARS OF EXPERIENCE PREFERRED
Orthopedic nursing. Knowledge of regulatory agency standards. Strong problem solving skills. Ability to manage multiple tasks and projects independently. Ability to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen certification.

PHYSICAL WORKING CONDITIONS
Sitting in a comfortable position with frequent opportunity to move about Sitting in a comfortable position with frequent opportunity to move about the department and traverse the hospital campus. Examples: executive, management, administrative and secretarial positions.

ENVIRONMENTAL WORKING CONDITIONS
Comfortable indoor area Located in a comfortable indoor area. Examples: executive, management and secretarial positions.

HAZARDS OSHA
Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment.

POSITION & UNIT ACCOUNTABILITIES

• Develops/Manages Processes & Systems - Assists with contracts Assists in the negotiation of physician managed care contracts, analytics, and financial modeling.

• Upholds Standards/Expectations of HSS Staff - Coordinates enrollment Coordinates physician enrollment in managed care plans.

• Upholds Standards/Expectations of HSS Staff - Ensures compliance Ensures compliance of managed care companies with negotiated contracts.

• Upholds Standards/Expectations of HSS Staff - Resolves payor issues Follows-up and resolving payment issues with Insurance Payors.

• Upholds Standards/Expectations of HSS Staff - Acts as liaison Acts a liaison between physician offices and Insurance Payors.

• Upholds Standards/Expectations of HSS Staff - Assists with meetings Schedules, coordinates, and documents for all PHO related meetings.

• Maintains Documentation & Manages Information - Maintains tracking logs Creates and maintains tracking logs for Insurance Payor issues and accountability for closing out items.

• Upholds Standards/Expectations of HSS Staff - Oversees PHO line Oversees PHO phone line, answers and responds to inquires, and assist with urgent physician office issues.

• Upholds Standards/Expectations of HSS Staff - Attendance Maintains satisfactory attendance record.

• Upholds Standards/Expectations of HSS Staff - Maintains punctuality Reports for duty punctually.

• Upholds Standards/Expectations of HSS Staff - Adjusts to change Adjusts to changing situations and work assignments.

EDUCATION REQUIRED
Masters in Social Work WITH LCSW

CERTIFICATIONS/LICENSURE REQUIRED
New York State LCSW

SKILLS PREFERRED
Ability to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen certification.

Non-Discrimination Policy
Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.