The Care Manager/Social Worker, as part of a multidisciplinary team, including the patient/family, physicians, nurse’s therapists, and payors ensures the patient’s progress in the acute episode of care through post discharge and is quality driven while being efficient and cost effective. The incumbent interacts with patients, family members, healthcare professionals, and community and state agencies in this effort.

The Care Manager/Social Worker serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information. The Care Manager/Social Worker reviews high risk patients from a psychosocial and medical perspective and assesses the psychological needs of patients and families and provides information, support, counseling, care management, and referrals to appropriate resources.

The MSW Care Manager and RN Care Manager work collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum. The expertise of the MSW is sought to resolve psychosocial patient care issues and to develop complex patient transition/discharge plan as needed.

The Care Manager/Social Worker is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series provides case review to third party payers and assisting in the denial and appeals process as well as assessing quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. The incumbent may have access to highly confidential patient, employee and/or Mercy proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm EST. It may be necessary, given the business need, to work occasional overtime. Our office is located at the following:

• 489 State Street Bangor, ME
• 778 Main St. South Portland, ME
• Northern AR Gould – 140 Academy St, Presque Isle, ME

Primary Responsibilities:

• Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care.
• Reviews patient charts
• Provides assessment, social services, and counseling to patients and their families in relation to social, psychological, financial, and family situations which will allow timely discharge facilitation.
• Obtains, interprets, and communicates necessary information regarding patients and families, including social history information, to staff and physicians.
• Performs clinical assessments and initiates interventions on assigned patients as appropriate to ensure optimal patient outcomes. Should be done through collaboration with multidisciplinary team.
• Attends Focus of Care rounds per unit schedule.
• Meets with patients and families to provide psychosocial support as needed.
• Facilitates and coordinates details of placement and actual discharge to appropriate agencies.
• Discusses nursing, psychosocial needs and medical information with facilities.
• Provides and updates referrals to facilities through online/software discharge planning tools.
• Reviews and completes all appropriate information accompanying patient facility.
• Acts as a liaison between hospital and those facilities should discharged patients be hospitalized. Arranges time and mode of transportation to facilities for patients.
• Facilitates and coordinates individualized discharge plan.
• Arranges and participates in care conferences with unit staff, home care staff, facility staff, patients and/or families.
• Provides adequate avenues of communication through on-going documentation in MediTech, eDischarge and telephone/verbal reporting or electronic tools.
• Coordinates and communicates with home care agencies regarding expected standards of care for requested specific treatments and psychosocial needs.
• Identifies and provides information on requested procedure, medicines and psychosocial needs.
• Assists patients and families with obtaining community assistance by referral to proper resources.
• Serves as a resource to physician and hospital personnel regarding available agency, facility, and community services to assist in discharge planning.
• Develops and maintains good working relationships with outside community health and social agencies. Reaches out to the community to develop new resources for meeting patient needs.
• Discusses specific continuing care needs with physicians and hospital personnel on a regular basis.
• Arranges and participates in care conference.
• Discusses on-going continuing care needs of patients with multidisciplinary team daily.
• Completes appropriate State of Maine forms.
• Monitors the completion of the MED by Goold for all first time Medicaid transfers to nursing facilities.
• Alerts Goold to complete The MED on Medicaid patients with expired bed holds.
• Alerts Goold to complete The MED on Medicaid patients with need for community programs.
• Ensures adherence to Quality Standards.
• Participates in departmental and hospital Quality Improvement programs.
• Provides adequate documentation of initial assessments, on-going writing of progress notes and reviewing of all referrals for accuracy and content prior to discharge.
• Accepts responsibility for further development of professional learning and growth.

Medical Record Review:

• Assumes integrated Care Management responsibilities when providing department weekend coverage.
• Conducts inpatient admission reviews for appropriateness of setting.
• Conducts on-going case review for continued stay criteria and enters data.
• Monitors quality of care using predetermined criteria.
• Reports potential risk management issues as through medical record review.
• Enters data as requested to support Quality Improvement initiatives in Midas.

Reporting:

• Documents in appropriate electronic system by the close of business each day.
• Consults with Physician Advisor and leadership as necessary to resolve barriers through appropriate administrative and medical channels.

Computer Skills:

• Demonstrates competency in accessing and documentation in Midas, Meditech, Milliman, eDischarge and email system
• Identifies patients and families in need of social work services
• Performs high-risk screenings
• Responds to patient and family request for case work services.
• Provides psychosocial assessments of the patients and families in relation to the crises of acute and chronic illness.
• Consult with patient to determine psychosocial concerns and needs.
• Meets with family for their input around concerns and needs in relationship to the illness.
• Reviews medical charts/nurse assessment forms for further insight into patient’s needs.
• Develops and implements appropriate treatment plans and interventions.
• Utilizes crisis interventions to mobilize resources in response to crises.
• Counsels and supports individual, families to help adjust and cope with illness.
• Make referrals to appropriate community resources.
• Refers patient and families to appropriate resources regarding insurance issues.
• Works as in advocate within and without the hospital.
• Assumes responsibility for own professional growth and on-going education
• Seeks opportunities to meet learning needs through workshops and literature.
• Maintains knowledge of necessary QIO transmittal services to facilitate appropriate level of care and denial activities within the hospital.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor's Degree (or higher)
• Minimum of 2+ years of clinical experience as a Social Worker in an extended care facility and / or community healthcare environment
• Minimum of 1+ years of experience with insurance coverage and / or various government programs
• Ability to work full-time, Monday – Friday between 8:00am – 4:30pm EST including the flexibility to work occasional overtime given the business need
• Ability to work onsite at one of the locations: (489 State Street Bangor, ME, 778 Main St. South Portland, ME, Northern AR Gould – 140 Academy St, Presque Isle, ME)
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Preferred Qualifications:

• Master’s Degree (or higher)
• Licensed Clinical Social Worker
• Direct experience with clinical trial operations, technology and/or health outcomes research for pharmaceuticals and/or medical devices 

Soft Skills:

• Critical Thinking skills
• Excellent written and oral skills
• Identifies challenges and problem solves with key stakeholders to reach solutions that meet the needs of customers
• Drive to consistently meet objectives and maintain focus
• Self-directed with proven organizational skills and ability to be flexible and work with ambiguity
• Ability to execute on identified deliverables either directly or influencing and driving internal and external partners
• Resourcefulness-ability to procure detailed data and information 
• Proven ability to boil down extensive research findings into relevant insights
• Detail-oriented and ability to identify potential risk or problems and recommend path to resolution
• Ability to interact one-on-one and consult with all levels of leadership

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.^SM

Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing together.?

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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