Behavioral Health Ur Case Manager - Behavioral Health - Full Time/Days - Req# 1929682765

Brief Description

Job Objective:

The Behavioral Health UR Case Manager is a non-clinical role that collaborates process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive behavioral health needs through communication and available resources to promote quality cost-effective outcomes. The UR Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge.

Duties and Responsibilities:

• Coordinates the discharge planning process ensuring involvement of all members of the healthcare team.
• Assesses and responds to patient/family needs by coordinating efforts of other team members.
• Knowledgeable of resident’s financial status, diagnosis and discharge needs.
• Communicate daily with admissions personnel regarding admissions and discharges to various units.
• Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
• Educates physicians and staff regarding appropriate level of care/utilization issues.
• Utilization Review and Discharge planning monitoring patient’s continuum of care.
• Collaborates and consults with physicians on patient's progress and discharge planning needs, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings regarding utilization management and discharge planning.
• Planning including implementation and annual review of the Utilization Management
• Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.
• Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
• Cooperate with insurance companies, based on information received.
• Identifies and resolves barriers that hinder effective patient care.
• Manages the process to review and, as appropriate, appeal denials received from payers.
• Perform and oversee needs analysis and planning. Work with executive leadership to ensure targets are met for the annual objectives.
• Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.
• Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness.

Non-Essential Duties:

• Maintain regulatory requirements, including all state, federal and local regulations.
• Maintain patient confidentiality at all times.
• Maintain patient confidentiality at all times.
• Assists in special projects and assignments.

Knowledge, Skills and Abilities:

Knowledge

• Thorough knowledge of mental health disorders and the ability to care for the psychosocial, cultural, spiritual and learning needs of the patients and their families.
• Knowledge and understanding of hospital and community resources.
• Knowledgeable of criteria for Medical, Medicaid, HMO and private insurance coverage.
• Basic knowledge of InterQual criteria.

Skills

• Good oral and written communication skills
• Basic computer skills required
• Strong assessment skills
• Skill and ability to follow the established Customer Service Expectations and Standards.
• Good critical thinking skills

Abilities

• Knowledge of the continuum of care and utilization process.
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to document in a clear and concise manner.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to determine appropriate course of action in more complex situations
• Ability to communicate effectively, both orally and in writing
• Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work
• Ability to complete work assignments accurately and in a timely manner

AVMC Values: All AVMC employees will effectively demonstrate these values:

• Patients Come First – We listen actively and communicate with our patients and families, placing safety as a top priority.
• Initiative & Innovation – Our can-do attitudes, creativity, and resourcefulness empower us to improve the patient’s experience, solve our own problems, make timely decisions, and look for opportunities to add value.
• Teamwork – We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
• Excellence – We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
• Accountability & Ownership – We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
• Tenderness & Compassion – We have genuine empathy, show kindness, and encourage and advocate for each other.
• Integrity & Honesty – We tell the truth at all times, speak up when something is wrong, and do the right thing when no one is looking.

Education and Experience:

Education

• Bachelor’s degree in Mental Health or related field required

Experience

• 7 years inpatient behavioral health experience

Required Licensure and/or Certifications:

• Utilization review experience preferred
• Case Management experienced preferred

AVMC Conduct/Compliance Expectations:

• Ability to adhere with AVMC Paid Time Off (PTO) Policy
• Ability to communicate effectively while maintaining good working relationships with co-workers, managers and other hospital staff
• Ability to maintain the confidentiality of patient, hospital and department information
• Ability to organize work and establish priorities
• Ability to adhere with AVMC Leaves of Absence Policy
• Ability to follow the Code of Conduct
• Ability to participate effectively in department and hospital staff education
• Display a willingness to work as a team player
• Ability to expand on own initiative in performance of duties
• Ability to adhere to safety rules and regulations
• Conforms with required and appropriate accreditation and regulatory requirements
• Ability to demonstrate knowledge and understanding of the Compliance & Integrity Program and its established policies.
• Skill and ability to follow the telephone etiquette/standards
• Ability to adhere with AVMC Attendance and Punctuality Policy
• Ability to function effectively under pressure and meet time parameters
• Ability to interpret and function under hospital and department policies and procedures
• Ability to adhere to the normal standards of courtesy and conduct as defined under the rules of hospitality at AVMC
• Ability to give and support the highest level of patient/customer satisfaction at all times
• Safely and effectively uses all equipment necessary to carry out duties
• Ability to adhere to the department dress code
• Conforms with and supports hospital quality assurance and improvement guidelines
• Supports and adheres to the values and mission statement established by the AVMC Board of Directors

Physical Requirements and Working Conditions:

• Workload may occur during times of unexpected circumstances, e.g., high activity, high census, and sudden emergencies relating to mental health patients.
• On occasion, will be called upon to assist in the physical management of assaultive patients.
• Frequent lifting of up to 10 lbs., with occasional lifting up to 25 lbs.

A detailed description of the physical requirements of this job is maintained in the Employee Health Department.

NOTE: THE ABOVE STATEMENTS ARE INTENDED TO DESCRIBE THE GENERAL NATURE AND LEVEL OF WORK PERFORMED BY PEOPLE ASSIGNED TO THIS JOB. THIS DOCUMENT IS NOT INTENDED TO BE AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES, SKILLS, AND WORKING CONDITIONS FOR THE PERSONNEL SO CLASSIFIED.

Requirements

Education

• Bachelor’s degree in Mental Health or related field required

Experience

• 7 years inpatient behavioral health experience