Behavioral Health Unit UR Case Manager - Full Time/Days - Behavioral Health Unit - Req#2030321499

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.

D uties and Responsibilities :

• Utilization Review and Discharge planning monitoring patient’s continuum of care.
• Assesses and responds to patient / family needs by coordinating efforts of other team members.
• Identifies and resolves barriers that hinder effective patient 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.

• Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.
• Manages the process to review and, as appropriate, appeal denials received from payers.
• Coordinates the discharge planning process ensuring involvement of all members of the healthcare team.
• Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
• Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
• Planning including implementation and annual review of the Utilization Management
• Communicate daily with admissions personnel regarding admissions and discharges to various units.
• Knowledgeable of resident’s financial status, diagnosis and discharge needs.
• Cooperate with insurance companies, based on information received.
• 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.

• Educates physicians and staff regarding appropriate level of care / utilization issues.
• Develop and implement methods, policies and procedures to improve the departments’ efficiency and overall effectiveness.
• Perform and oversee needs analysis and planning. Work with executive leadership to ensure targets are met for the annual objectives.

Non-Essential Duties :

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

Knowledge, Skills and Abilities :

Knowledge

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

Skills

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

Abilities

• Ability to determine appropriate course of action in more complex situations
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to complete work assignments accurately and in a timely manner
• Ability to communicate effectively, both orally and in writing
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner
• Knowledge of the continuum of care and utilization process.
• Ability to document in a clear and concise 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.
• Accountability & Ownership We fully complete tasks, are transparent, effectively communicate, and recognize that what we do reflects on us.
• Teamwork We build trusting relationships, promote a sense of community, and are respectful of everyone. Success is about the whole team.
• 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.
• Excellence We take pride in our work, are goal-oriented, and on a never-ending quest for top tier quality.
• 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.
• Tenderness & Compassion We have genuine empathy, show kindness, and encourage and advocate for each other.

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 :

• Case Management experienced preferred
• Utilization review experience preferred

AVMC Conduct / Compliance Expectations :

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

Physical Requirements and Working Conditions :

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

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 :

• Case Management experienced preferred
• Utilization review experience preferred
14 days ago