Insurance Utilization Review Jobs in Trumbull, CT

LICENSED CLINICAL SOCIAL WORKER- Danbury Hospital - $5,000 Sign On Bonus

Summary:

Performs assessments and formulates treatment plan and or discharge/transition plans in collaboration with patient, provider, and possible family and multidisciplinary healthcare team. Provides ongoing monitoring and evaluation of plans to meet the individual needs of patients throughout the care continuum. Assists in resource management through facilitation of care and participation in program planning, data collection and analysis. Provides education to patients/families regarding coverage, care options and community resources.

Responsibilities:

1.Care Coordination/Facilitation and Transition Management - coordinates multiple aspects of care to all appropriate patients to ensure the patient overall health goals improve and their psychosocial wellbeing.

2. Assesses patient's clinical readiness for transition in collaboration with the healthcare team and informs the team of the available resources based on the patient's clinical needs. Maintains easy flow of communication regarding patient's development and progress to all involved in care of patient.

3. Participates in the development and improvement of clinical initiatives focused on reducing hospital admissions or trips to the ED, or Re-admissions and ensuring appropriate levels of care. Actively involved in all daily, weekly or monthly provider or staff or supervision rounds/meetings. Knowledge of hospital and community resources and is a resource for the healthcare team.

4. Maintains effective relationships and a positive outlook when interfacing with other departments, multidisciplinary healthcare team as well as patient's/families and community providers.

5. Acts as an intermediary between patients, physicians and community providing advocacy, accurate healthcare information, potential referral services and proper treatment plans. Initiates and coordinates patient care conferences as required and will do home visits as necessary.

6. Social Work Care Coordinators provide clinical social work interventions which include counseling, bereavement, brief goal focused therapy and utilizes different modalities SBIRT, MI, CBT, DBT, mindfulness, ect. and crisis intervention as well as assessment and intervention in cases involving complex family/patient dynamics. Participate in Simulation Lab and promoting SBIRT and MAT in the PC offices.

7. Assist the primary care team in developing care management processes such as the use of guidelines, disease management techniques, case management, and patient education to improve self-management of chronic disease.

8. Utilization Review Care Coordinators reviews all admissions and continued stays for assigned group of patients to determine certification to the assigned level of care utilizing standardized criteria to achieve optimal outcomes and reimbursements. Provides timely clinical information to the commercial insurers. Coordinates direct communication between MD's and insurers to proactively avoid denials. Identifies variances, avoidable days, readmission and LOS issues and works with department leadership and the healthcare team to develop changes in process to improve outcomes. Collaborates with other members of care coordination to communicates changes in level of care as well as other pertinent information required for an optimal transition plan. Provides education to patient/families and the healthcare team.

9. High Risk Care Coordinators coordinate care for a group of patients with a specific diagnosis and/or complex discharge needs across the continuum. Provides assistance and support in collaboration with the healthcare team to ensure that patients are given all available resources to meet their healthcare goals and improve self-management of their health/disease process.

10. Maintains confidentiality on relevant issues and information. Takes accountability for personal performance and goal achievement. Takes initiative to set high standards of honesty, integrity and performance for self and others.

11. Collaborates effectively with team members, develops good relationships both inside and outside of the team. Constructively works through problems/issues without becoming defensive or antagonistic. Contributes ideas and supports decisions made by the team and the organization. Always treats others with dignity and respect.

12. In accordance with all regulatory requirements, documents accurately, objectively and timely, the patient's plan of care and treatment modalities and interventions.

13. Identifies patient safety and quality issues and reports to appropriate individuals. Uses high reliability principles to ensure patient safety and quality outcomes.

14. Western CT Medical Group Primary Care Offices in the Northern and Southern regions of CT for possible collaboration and coverage main location of work will be Health Quest primary care offices in NY state. Facilitates the Behavioral Health integration in primary care as the onsite Behavioral Health LCSW performing behavioral health assessments, develop treatment plan and provide brief interventions utilizing various treatment modalities such as CBT, MI, grief counseling, tapping, goal setting, insight oriented supportive counseling, mindfulness, SBIRT and as needed referrals and recommendations for treatment and community services.

15. Fulfills all compliance responsibilities related to position, performs all other duties as assigned.

16. Performs other duties as assigned.

Education Skills Experience:

• Master's degree in Social Work from an accredited school
  Minimum of five years experience 
  Current NYS and CT Licensed Clinical Social Worker (LCSW)
• Credentials:LCSW

Company: Nuvance Health Med Practice CT

Org Unit: 503

Department: DB Psychiatry

Exempt: Yes

Salary Range: $33.21 - $61.68 Hourly