Inpt Insurance Coord

Job Description
About Us

We’re Maimonides Health, Brooklyn’s largest healthcare system, serving over 250,000 patients each year through the system’s 3 hospitals, 1800 physicians and healthcare professionals, more than 80 community-based practices and outpatient centers. At Maimonides Health, our core values H.E.A.R.T drives everything we do. We uphold and maintain Honesty, Empathy, Accountability, Respect, and Teamwork to empower our talented team, engage our respective communities and adhere to Planetree's philosophy of patient-centered care. The system is anchored by Maimonides Medical Center, one of the nation’s largest independent teaching hospitals and home to centers of excellence in numerous specialties; Maimonides Midwood Community Hospital (formerly New York Community Hospital), a 130-bed adult medical-surgical hospital; and Maimonides Children's Hospital, Brooklyn's only children's hospital and only pediatric trauma center. Maimonides' clinical programs rank among the best in the country for patient outcomes, including its Heart and Vascular Institute, Neuroscience Institute, Boneand Joint Center, and Cancer Center. Maimonides is an affiliate of Northwell Health and a major clinical training site for SUNY Downstate College of Medicine.

Overview

Partners with the psychiatry inpatient Social Worker/ Social Worker Assistant to form the clinical case management team. Develops, plans, organizes, implements, coordinates, monitors and evaluates activities related to the outcome management of patients through the Continuum of Care from preadmission through admission to post-discharge; acts as liaison with nursing, medical staff and other clinical departments to integrate the Department’s functions and services with other aspects of the patient care process.

Responsibilities

For direct care providers: Provides age appropriate care and intervention for age of patients served according to job description (e.g assessments, treatment plans, assists with assessments)
For non-direct care providers: Provides support services using age appropriate interpersonal communication
Coordinates discharges that require services of a certified home health agency
Negotiates with vendors, providers and mental health agencies to optimize services
Collaborates with managed care companies to facilitate appropriate use of benefits and services to patients (e.g., obtains optimum coverage for patients while in hospital; negotiates appropriate outpatient services with company-approved agencies or arranges for use of alternate agency)
Functions as clinical resource person for the multi disciplinary health care team, patient and family on insurance benefits, managed care process, clinical and utilization review issues in order to maximize quality of patient care and effectively manage length of care
Applies appropriate third part payor procedures regarding financial coverage, non-coverage and alternate level care. Explains and distributes notifications to patient and /or family representative
Assists in the completion of discharge in a timely manner
Reviews all admissions within 24-48 hours to ensure they are appropriate for acute care. Identifies potential treatment and discharge problems (e.g. patient has no appropriate place to go on discharge). If admission is assessed as inappropriate, consults with responsible physician to clarify the plan of care
Acts as liaison with social work, nursing and psychiatric staff and other clinical departments to integrate the department’s functions and services with other aspects of the patient care process
Consults and collaborates with physicians and other members of the health care team to coordinate plan of care, determine the most cost effective use of hospital resources, and remove obstacles to timely, efficient discharge
Collects and analyzes patient data to advise the health care team on appropriateness of care, patient outcomes and other relevant continuum of care issues
Facilitates the development of multidisciplinary care plans for identified patient populations. Active participant in interdisciplinary rounds
Identifies potential alternate level of care (sub-acute) patients; consults with admitting physician to determine the need for acute care admission and discuss alternate plan of care; collaborates with health care team to arrange appropriate placement and ensure appropriate documentation is complete
Maintains a leadership role in health care team to ensure high quality patient care; identifies health care team educational needs and participates in developing and implementing programs; coordinates multi disciplinary rounds, referrals and case conferences
Performs chart reviews, which includes among other matters length of stay, resource management, compliance with managed care contracts, patient outcomes, sequence and scheduling of tests/ treatment(s), consultations, variations in care delivery or implementation of algorithms. Reports variations to physician’s advisor, clinical chairman or appropriate discipline
Customer Service: respect, flexibility, knowledge, confidence, professionalism, pleasant attitude, patience and helpfulness, All responses should be timely, professional, caring, and respectful in accordance with Customer Service Performance expectations
Maintains established departmental policies and procedures, objectives, quality assurance program, safety, environmental, and infection control standards

Qualifications

Education: LMSW required, LCSW preferred

Experience: Minimum of 3 years of direct experience in utilization management, managed care liaison, discharge planning, case management and inpatient psychiatry experience preferred.

Skills:

Current clinical and technical social work skills.

Knowledge of rules and regulations of child abuse/neglect reporting as appropriate.

Familiarity with requirements of regulatory agencies and third party payor.

Demonstrated ability to use word processing, spreadsheet and/or database programs as required by the position.

Excellent oral and written communication skills.

Good problem-solving, decision-making and judgment skills.

Good interpersonal skills.

Speaks, reads and writes English to the extent required by the position; knowledge of a second language preferred.