SOCIAL WORKER MSW - ED

Independence Health System; Greensburg (Westmoreland County); On-site; USD 65,000 - 90,000; Full time

Job summary

Independence Health System in Greensburg, PA seeks an experienced Emergency Department Social Worker to coordinate discharge planning, case management, and utilization review for ED patients. The role involves applying InterQual criteria, coordinating post-acute care, and collaborating with ED physicians and care teams to ensure appropriate levels of care and efficient patient throughput.

You will provide psychosocial support, facilitate community resource connections, and participate in

Qualifications

• Master’s in social work required.
• 3 years of ED, utilization, or case management experience.
• Strong leadership, organizational, and critical thinking skills.
• Knowledge of legal aspects and liability in nursing practice.
• Licenses/certifications as required by state (Act 33/34) with FBI clearance.

Responsibilities

• Coordinate discharge planning for ED patients and arrange post-acute care.
• Apply InterQual criteria to determine level of care.
• Collaborate with ED physicians and care teams.
• Provide psychosocial support to patients and families.
• Facilitate utilization review and denial management processes.

Skills

Leadership

Organizational skills

Critical thinking

Communication with medical staff

Legal/Regulatory knowledge

Education

Master’s degree in Social Work

Job description

The ED SW assesses, coordinates, facilitates, and negotiates services and resources for the ED population in order to achieve desired clinical and financial outcomes. The ED SW reviews clinical criteria to ensure the appropriate level of care for patients presenting to the Emergency Department, as well as those patients referred directly from the physician's office. After review of clinical data and application of objective screening criteria (InterQual Level of Care criteria), the ED SW will consult with the Emergency Department Physician for recommendations regarding appropriate patient status, i.e. acute inpatient admission vs. observation services vs. an alternate level of care, prior to contact with the attending physician. The ED SW coordinates discharge plans for those ED patients requiring follow-up or post-ED care after discharge from the ED, including referrals to Personal Care, Skilled Nursing Facility placement, Home Health, Durable Medical Equipment, etc.

Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one’s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela’s missions, vision and values.

1. Regular, consistent, on-site, and timely attendance.
2. Plans, organizes, and coordinates plan of care on assigned patients
   1. Assesses/reassesses patient, family, medical and psychosocial factors that impact plan of care for the patient.
   2. Completes accurate, timely, and appropriate documentation of interventions to execute plan of care.
   3. Communicates plan of care to members of the health care team via attendance at Collaborative Care rounds, concurrent documentation and verbal communication.
   4. Evaluates and projects discharge planning needs and coordinates post-acute care needs of patients in assigned case load.
3. Demonstrates knowledge/application of acute care criteria
   1. Demonstrates extensive knowledge of community and payor resources to facilitate transition/discharge planning.
   2. Coordinates post-hospital needs in a timely and effective manner.
   3. Identifies, tracks and trends Avoidable/Delay Days in Midas system.
   4. Makes referrals to CRM Manager or designee for complex cases
4. Thorough knowledge of social work principles, techniques, and practices and their application to complex patient/family/organizational needs.
   1. Provides therapeutic goal-directed counseling services to patients and their families on a limited basis in order to facilitate the discharge planning process.
   2. Applies advanced interpersonal skills in negotiating appropriate plan of care needs for assigned patient population.
   3. Acts as a resource/consultant to internal customers for extensive knowledge of community resources and expertise in accessing social/community systems.

“Ability to perform the Essential Functions on the Physical Conditions chart; and the ability to perform the Essential Functions on the Working Conditions chart (see attached charts)”

1. Level of Care Management
   1. Reviews clinical criteria of all ED / Direct Admission patients for appropriate patient type (i.e. inpatient, observation services, outpatient testing/treatment) based on medical necessity criteria.
   2. Discusses recommendations for level of care with ED physician and attending physician.
   3. Discusses options for care with patients, families, and physicians involved in their care.
   4. Remotely monitors bed board (where applicable).
2. Psychosocial
   1. Assists patients and their families through the complex emergency room environment and/or the hospitalization process.
   2. Provides emotional support to patients and their families/support system as needed.
   3. Connects patients and their families/support system to community services as needed and appropriate.
3. Discharge Planning / Case Management
   1. Plans, coordinates, and implements discharge plans for ED patients, including but not limited to, referrals to skilled nursing facilities, personal care homes, home health, DME, transportation, or community based services.
   2. Coordinates authorization for admitted patients and/or patients transferred from the ED.
   3. Provides case management follow through for the Unit Based Case Manager on cases requiring follow-through after normal business hours.
4. Professional Development
   1. Attend meetings as appropriate and meet regularly with supervisor to exchange pertinent information.
   2. Participates in continuing education activities, remaining knowledgeable in area(s) or expertise.
   3. Maintains a high level of ethical conduct regarding confidentiality, dual-relationships and professional stature.
   4. Maintains patient and program records in accordance with applicable standards and regulations, grant requirement, etc.
5. Utilization
   1. Applies InterQual level of care criteria for Severity of Illness/Intensity of Service Indicators. Makes referral to PA or designee for second level review in cases not meeting initial SI/IS screens.
   2. Recognizes and progresses the plan of care when an alternative level of care is appropriate.
   3. Collaborates with the attending physician and other members of the healthcare team to facilitate the progression of the plan of care.
   4. Cognizant of payor requirements for all patients in assigned caseload. Responsible for understanding and communicating plan benefit limits/availability to patient or their representative in management of case as necessary.
   5. Responsible for accurate and timely documentation in recognized databases to support Clinical Resource Management and ED components for each patient in assigned caseload.
6. Denial Management
   1. Initiates contact with the attending physician on cases that do not meet InterQual Level of Care SI/IS indicators in order to clarify plan of care.
   2. Educates physicians and other members of the healthcare team on the application of InterQual Level of Care Criteria to support an acute level of care and provides alternatives to acute care as appropriate.
   3. Notifies the unit based case manager of all real or potential cases in which an adverse determination or complex psychosocial situation is anticipated.
   4. Identifies and facilitates transition to the most appropriate alternate level of care.

Required Qualifications

• * Master’s in Social Work
• * 3 years of recent experience in Emergency Department, Utilization, or Case Management experience in Healthcare.
• * Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.

License, Certification & Clearances

• Act 33 with renewal
• Act 34 with renewal
• Act 73 FBI Clearance with renewal

Required

Masters or better in SOCIAL WORK.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.