Job Posting: Discharge Planning Utilization Management Social Worker

Job Summary

We are seeking a dedicated Social Worker to join our Discharge Planning Utilization Management (UM) team. The role involves assessing member needs from the time of hospital admission, skilled nursing facility admission, or observation bed stay through discharge or transfer to the next level of care. The successful candidate will identify needs and solutions in collaboration with facility staff, members, and caregivers to develop a high-quality, safe discharge plan. This position also requires working with authorization and utilization management teams to generate timely requests for medical services and making clinical determinations in accordance with healthcare policies and regulations.

Job Functions

• Deliver timely notifications of clinical decisions related to discharge.
• Identify potential barriers to discharge, including social needs, food/housing insecurity, and financial issues; link members to appropriate community resources upon discharge and follow up as needed.
• Collaborate with management, physicians, member representatives, vendors, caregivers, and facility discharge planners to coordinate discharge planning and transition of care.
• Review Daily Facility Census reports to identify activities at assigned facilities and initiate the discharge planning process.
• Provide education to discharge planning staff on available member benefits.
• Participate in weekly review rounds and interdisciplinary care team meetings.
• Conduct Social Determinants of Health (SDOH) evaluations and connect members to community-based providers and services.
• Identify opportunities for alternative care options and contribute to the development of member-focused care plans to facilitate safe discharge and transition back into the community.
• Coordinate with Authorization and Utilization Management teams to ensure required authorizations are complete and transferred to appropriate vendors.

Qualifications

• Education:
  • Associates Degree in Nursing or Masters Degree in Social Work required.
  • Bachelors Degree in Nursing preferred.
• Experience:
  • Minimum two years of strong case management/discharge planning background or acute inpatient hospital experience in discharge planning required.
  • Knowledge of Medicare and Medicaid regulations required.
  • Experience working with community-based organizations in underserved communities required.
  • Excellent organizational, time management, interpersonal, and communication skills required.
  • Working knowledge of Microsoft Excel, PowerPoint, and Word required.
• Licenses and Certifications:
  • Current license to practice as a Registered Professional Nurse in New York State for RNs required.
  • Current license to practice as a Social Worker in New York State for SWs required.
  • Certified Case Manager preferred.

Position Details

• Location: Mainly remote but may require up to six in-office visits per year.
• Hours: Monday - Friday, 8:30 AM - 4:30 PM.
• Salary: $70,000 - $78,000 per year.
• Additional Requirements: Must be an LMSW or LCSW in NY with hospital discharge planning experience.