Social Worker Care Coordinator

Position Title: Social Worker Care Coordinator

Department Name: Case Management

UPH Affiliate: Quad Cities

Department Number: 6010-9052350

Effective Date: 1/5/2004

Review Date(s): 1/5/2004, 05/03/05, 05/21/07, 04/22/11,

08/02/12, 12/17/14

Prepared By: Erica Meier

Approved By:

Position Reports To: Manager of Care Coordination

Description of Position:

Provide a "snapshot" or the principal purpose or focus of the position, consisting of no more than three to five sentences. This summary should provide enough information to differentiate the major function and activities of the position from those of other positions.

Responsible for the coordination of care and services for the patient through collaboration with the interdisciplinary team. Monitors plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, transitions of care, discharge planning, referrals to appropriate community agencies and assists with advance directives when appropriate. Provides leadership and promotes communication and collaboration among members of the interdisciplinary team, patients and families to ensure that specific patient outcomes are achieved and variances are evaluated and addressed as needed. Collaborates with members of the interdisciplinary team to achieve department and hospital goals related to coordination of care, reducing readmissions and managing length of stay.

Essential Functions/Responsibilities:

Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

% of Time

(annually)

Discharge Planning

* Facilitates the coordination of discharge planning to assure excellence in patient care and patient flow

* Assess patient's clinical and psychosocial needs, identifies risk factors and develops plan based on identified needs

* Identifies needed interventions, communicates and collaborates with physicians and primary nurse to individualize plan of care

* Collaborates with patient, family, and other members of the healthcare team to address patient needs related to care coordination

* Coordinates and facilitates interdisciplinary planning and communication through care coordination rounds, complex care meetings, unit specific staff meetings

* Facilitates meetings with patients, significant others, and providers to ensure participation in the plan of care and discharge planning

* Researches and facilitates referrals to appropriate community agencies

* Identifies need for POA or advance directives and assists with completion of AD documents

* Coordinates orientation for the patient to the services and outcomes predicted

60 %

Regulatory

* Adheres to the requirements of CMS, The Joint Commission and other payers related to coordination of care, discharge planning, patient interventions and documentation

* Develops, maintains, and performs utilization management in the provision of medical necessary services, determine appropriate level of care for discharge planning, and efficient use of resources

* Communicates with UM Specialist to ensure medical necessity and appropriate patient class for hospital stay and qualifications met for next level of care

* Document all necessary components related to discharge planning in the electronic medical record

15%

Quality

* Through appropriate discharge planning, monitor quality assurances such as patient experience, length of stay, and reduction of readmissions

* Collaborates with team members in planning and implementation of strategies to manage length of stay and prevent readmissions

* Assists in constructive evaluation of departmental services through participation in the Quality Improvement projects and implementation of systems to increase effective case management by all members of the health care team

* Maximizes positive financial outcomes for patients and hospital by reviewing medical record and making recommendations as needed to insure appropriate coordination of care, length of stay, discharge planning, and quality of care

15 %

Basic UPH Performance Criteria

* Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines

* Demonstrates ability to meet business needs of department with regular, reliable attendance.

* Employee maintains current licenses and/or certifications required for the position

* Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare

* Completes all annual education and competency requirements within the calendar year

* Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance

10%

Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Demonstration of UPH Values and Standards of Behaviors

Consistently demonstrates UnityPoint Health's values in the performance of job duties and responsibilities

Foster Unity:

* Leverage the skills and abilities of each person to enable great teams.

* Collaborate across departments, facilities, business units and regions.

* Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment:

* Connect with each person treating them with courtesy, compassion, empathy and respect

* Enthusiastically engage in our work.

* Accountable for our individual actions and our team performance.

* Responsible for solving problems regardless of the origin.

Champion Excellence:

* Commit to the best outcomes and highest quality.

* Have a relentless focus on exceeding expectations.

* Believe in sharing our results, learning from our mistakes and celebrating our successes.

Seize Opportunities:

* Embrace and promote innovation and transformation.

* Create partnerships that improve care delivery in our communities.

* Have the courage to challenge the status quo.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

Master's Degree in Social Work required.

Experience:

1-2 Years post graduate experience.

Previous utilization review, case management and/or care coordination experience preferred. Three to five years' experience in hospital, intermediate care or home care setting preferred.

License(s)/Certification(s):

Social Work license in Iowa and Illinois required. (License in second state must be obtained within 30 days of hire.)

CPR certification upon hire.

Valid driver's license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

Must have thorough knowledge of community resources and agencies. Must have excellent communication skills, both oral and written including the ability to communicate with physicians, hospital staff, patients, families and community agencies. Requires the ability to negotiate and establish effective working relationships with members of the interdisciplinary health care team. Must demonstrate ability to identify and act upon psychosocial needs and work independently in outcome oriented environment. Above average computer skills and software programs required.

Knowledge of Medicare Conditions of Participation and IDPH, Joint Commission Standards preferred.

Other:

Use of usual and customary equipment used to perform essential functions of the position.

Number of Employees Supervised (Complete if position has supervisory responsibilities of individuals)

Direct

Indirect

Total

Exempt

Non-Exempt

Total

Budget Control (Complete if position has budget responsibilities)

Annual Operating Budget (including payroll)

Annual Revenue/Sales

Other Scope Measurements

Pertinent to the position, such as number of beds, number of units/departments, number of employees leading, cases per month, etc.

Item

Number

Mental/Cognitive Demands:

(List any special mental and cognitive abilities required by the position in your specific environment)

* Must be able to communicate effectively with people of diverse backgrounds, professions, educational levels, and lifestyle backgrounds

* Excellent communication skills, oral and written

* Maintain strict confidentiality at all times

* Demonstrates professional behavior ALWAYS

* Treat others with dignity and respect

* Must be able to cope effectively under pressure and in stressful situations

* Ability to work under time constraints

* Demonstrate excellent critical thinking skills and be able to prioritize work tasks effectively

* Demonstrate a cooperative, courteous, and dependable working performance

Physical Requirements

(Check all that apply if essential to perform job - with or without accommodations)

Talk/Hear (communicate, detect, converse with, discern, convey, express oneself, exchange information)

See (defect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, assess)

Stand or Sit (stationary position)

Walk (move, traverse)

Use hands/fingers to handle or feel (operate, activate, use, prepare, inspect, place, detect, position)

Climb (stairs/ladders) or Balance (ascent/descent, work stop, traverse)

Bend/Stoop/Kneel

Squat/Crouch/Crawl

Reaching/Twisting

Taste/Smell (detect, distinguish, determine)

Pushing/Pulling

Lifting Requirements

(Check appropriate category to perform job - with or without accommodations)

Level 1; Sedentary Work: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Level 2; Light Work: Exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Requires walking or standing to a significant degree, pushing or pulling arm or leg controls or maintaining a production rate pace. Light work requires physical exertion of forces greater than that of sedentary work.

Level 3; Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

Level 4; Heavy Work: Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

Level 5; Very Heavy Work: Exerting in excess of 100 pounds of forces occasionally, and/or in excess of 50 pounds of force constantly to move objects.

Hazards and Atmospheric Conditions

(check all that apply)

Normal Office Surroundings

Vibration

Exposure to Fumes

Mechanical Hazards

Exposure to Dust

Chemical Hazards

Exposure to Extreme Temperatures

Electrical Hazards

Wet and/or Humid

Radiant Energy Hazards

Noise

Explosives Hazards

Mists or Gases

Burn Hazards

Other/Comments:

Precautions must be followed when working in any health care environment.

OSHA Categories

(Complete this OSHA section for clinical/patient related jobs)

Category I: Duties performed routinely require exposure to blood, body fluid and tissue.

Category II: Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.

Category III: Normal routine involves no exposure to blood, body fluid, or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

To Be Completed by Compensation Analyst

FLSA Designation:

Lawson Job Level:

Lawson Job Category:

Lawson Job Sub-Category:

Lawson Job Code:

Lawson Job Title:

Short Term Incentive Eligibility:

Union Affiliation: