YEARS OF EXPERIENCE REQUIRED
Two years experience in case management with discharge planning or equivalent in acute or home care clinical setting.
YEARS OF EXPERIENCE PREFERRED
Orthopedic nursing. Knowledge of regulatory agency standards. Strong problem solving skills. Ability to manage multiple tasks and projects independently. Ability to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen certification.
PHYSICAL WORKING CONDITIONS
Sitting in a comfortable position with frequent opportunity to move about Sitting in a comfortable position with frequent opportunity to move about the department and traverse the hospital campus. Examples: executive, management, administrative and secretarial positions.
ENVIRONMENTAL WORKING CONDITIONS
Comfortable indoor area Located in a comfortable indoor area. Examples: executive, management and secretarial positions.
HAZARDS OSHA
Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment.
POSITION & UNIT ACCOUNTABILITIES

• Develops/Manages Processes & Systems - Assists with contracts Assists in the negotiation of physician managed care contracts, analytics, and financial modeling.

• Upholds Standards/Expectations of HSS Staff - Coordinates enrollment Coordinates physician enrollment in managed care plans.

• Upholds Standards/Expectations of HSS Staff - Ensures compliance Ensures compliance of managed care companies with negotiated contracts.

• Upholds Standards/Expectations of HSS Staff - Resolves payor issues Follows-up and resolving payment issues with Insurance Payors.

• Upholds Standards/Expectations of HSS Staff - Acts as liaison Acts as a liaison between physician offices and Insurance Payors.

• Upholds Standards/Expectations of HSS Staff - Assists with meetings Schedules, coordinates, and documents for all PHO related meetings.

• Maintains Documentation & Manages Information - Maintains tracking logs Creates and maintains tracking logs for Insurance Payor issues and accountability for closing out items.

• Upholds Standards/Expectations of HSS Staff - Oversees PHO line Oversees PHO phone line, answers and responds to inquires, and assist with urgent physician office issues.

• Upholds Standards/Expectations of HSS Staff - Attendance Maintains satisfactory attendance record.

• Upholds Standards/Expectations of HSS Staff - Maintains punctuality Reports for duty punctually.

• Upholds Standards/Expectations of HSS Staff - Adjusts to change Adjusts to changing situations and work assignments.

EDUCATION REQUIRED
Masters in Social Work WITH LCSW
CERTIFICATIONS/LICENSURE REQUIRED
New York State LCSW
SKILLS PREFERRED
Ability to assess clinical and discharge needs of orthopedic surgical patients. Knowledge of Milliman (MCG) criteria. PRI/screen certification.