The Case Manager is responsible for managing the healthcare needs, facilitation and achievement of quality and cost outcomes of all patients . The case manager, utilizing a multidisciplinary team approach, negotiates, procures, coordinates and monitors services and resources needed by patients. The case manager is responsible for reviewing the patient at admission, and in some instances prior to admission, and concurrently throughout the hospital stay for the appropriate level of care and utilization of resources. The case manager will perform transition care planning activities to secure appropriate post hospital care arrangements and will monitor the patient during the course of their hospitalization. The case manager participates with the performance improvement initiatives .

REQUIREMENTS

• Masters in Social Work Required
• LCSW - Licensed Clinical Social Worker Required
• LICSW - Strongly Preferred
• 3 years clinical experience in acute care in areas such as internal medicine, surgery, orthopedics, mother/child, cardiology, oncology, psychiatry
• 3 years clinical experience in Rehab Setting, Home Health and Long-Term Care would be considered.
• Ability to perform a comprehensive admission and discharge risk assessment related to quality, financial, payer benefit allowances and limitations, risk management and patient satisfaction.
• Experience specializing in utilization management (levels of care knowledge and demonstrable competence with evidence based criteria tools), discharge planning to entities throughout a continuum of care
• Previous care management or third party insurance review preferred
• Current knowledge of CMS (levels of care determinations), appeal rights & DPH regulations required
• Current knowledge of Kepro QIO (appeals) required
• Knowledge of regulatory and accreditation organizations such as Joint Commission, DPH and HealthGrades preferred

• CERTIFICATION REQUIREMENTS
• BLS (AHA)

STATE LICENSE REQUIREMENTS

• Massachusetts

Job Type: Temporary

Schedule:

• 8 hour shift
• Day shift

Work setting:

• Inpatient
• In-person

Experience:

• acute care: 3 years (Required)

License/Certification:

• MA state license (Required)
• BLS Certification (Required)
• Licensed Certified Social Worker Certification (Required)

Ability to Relocate:

• Pittsfield, MA: Relocate before starting work (Required)

Work Location: In person