Care Management Specialist - Behavioral Health - Day

Essential Functions:

• Identifies needs of individuals and takes action to address these needs in conjunction with appropriate staff member/disciplines in a timely manner. Reports occurrences of physical or emotional abuse and/or neglect.
• Coordinates appropriate cost-effective discharge planning, based on assessment of patient needs and input from multidisciplinary team.
• Works with physicians, staff from other departments, third party payors, families, community resources, etc. to facilitate transition of the patient throughout the continuum at the appropriate level of care.
• Uses advance knowledge of healthcare, community resources, and recovery principles of care to plan and implement new or revised services.
• Assists with the development, revision, and coordination of the Plan of Care through daily rounds, collaboration with the multidisciplinary treatment team, and communication with physicians, nurses, and other healthcare team members to meet the patients' needs effectively and efficiently.
• Identifies system/organizational processes which may affect effective utilization of resources, timely scheduling of tests, appropriate level of care being given, etc., and collaborates with team members to improve upon the processes.
• Applies and effectively utilizes problem-solving techniques and conflict resolution to coordinate patient care.
• Serves as a resource contact and information source to patients, families, significant others, and staff.
• Maintains knowledge and satisfactorily complies with regulatory and third-party payors' procedures, notification requirements and criteria, documentation required in the medical record, etc.
• Minimizes financial loss to the organization through proactive identification and investigation of issues related to precertification, reimbursement, denials, insurance availability, etc., and promptly notifies physician.
• Thoroughly and accurately documents actions/communication surrounding discharge planning and/or utilization management in the medical record.
• (BHU Only) Incorporates recovery principals into providing patient care.
• (BHU Only) Effectively organizes and provides leadership in treatment team meetings
• (BHU Only) Effectively conducts patient and family counseling sessions and education
• (BHU Only) Effectively facilitates therapeutic group treatment modalities (counseling, discharge planning, family support and education, etc.)
• (BHU Only) Provides brief individual, family, couple, and 1:1 counseling.
• (BHU Only) Communicates findings and pertinent information related to the patients' hospitalization, length of stay, discharge planning, documentation requirements, insurance and reimbursement status to the appropriate department and/or staff. Accurately documents pertinent information in the UR module.
• (BHU Only) Demonstrates understanding and effective implementation of role in maintain therapeutic and safe milieu
• (BHU Only) Conducts and documents social history and psychosocial assessments accurately and within required time frame.
• (BHU Only) Describes Level of Care Policy, including responsibility and hand off process for minimum promise of every 15-minute safety checks
• (BHU Only) Incorporates Continuous Comprehensive Integrated System of Care (CCISC) principles into providing patient care.
• (BHU Only) Ensures timely and comprehensive completion of admission, continued stay, and discharge reviews, using medical care review criteria. Provides third party payors with status reports and enters information and results in the UR module within required time frames.
• (BHU Only) Completes variances and/or denials report and UR Module functionality in a timely manner.
• (BHU Only) Obtains information that is provided to third party payors, or if criteria is not met, to the physician. Facilitates physician conference calls to address reimbursement and quality of medical care reviews.
• (BHU Only) Achieves, maintains, and demonstrates Non-Violent Crisis Intervention Skills (CPI certification)
• (BHU Only) Effectively represents BHU on the hospital Utilization Management Committee
• • (Inpatient Rehab only) Assess patients for eligibility and clinical needs for post-acute inpatient services: Completes the Inpatient Rehabilitation Facility Pre-Admission Screen Consults with the Rehabilitation Physician for final Inpatient Rehabilitation Facility admission determination including third party payor authorization.
• (Inpatient Rehab only) Works with physicians, patient and significant others, the healthcare team (including finance department), third party payors, etc. to facilitate transition of the patient throughout the Inpatient Rehabilitation admission and post discharge plan of care.
• (Inpatient Rehab only) Responsible for coordination and facilitation of Patient and Family Conferences, Team Conferences, Huddle, and family teaching.
• (Inpatient Rehab only) Responsible for re-authorization by third party payors for patient continuing stay on Inpatient Rehabilitation.
• Inpatient Rehab only) Completes Medicaid late pick up calls.
• (Inpatient Rehab only) Acts as liaison to outside facilities for patient admission.
• (Inpatient Rehab only) Responsible for completing Medicare rights process.
• (Inpatient Rehab only) Assists with the Discharge Planning Department's Care Coordination functions as needed.

Common Expectations:

• Demonstrates service excellence and patient and family centered care by showing respect, honesty, fairness, and a positive attitude toward all customers.
• Maintains confidentiality.
• Demonstrates dependability, to include attendance and punctuality.
• Is accountable - takes initiative and ownership of issues.
• Displays a professional demeanor. Represents hospital in a positive way. Has a compassionate working relationship with patients and families.
• Assumes personal responsibility for 2-way communication. Communicates and listens effectively with patients, families, coworkers, other departments, physicians/providers and community.
• Supports coworkers, initiatives and a patient and family centered philosophy; pitches in; does own part and helps others.
• Works to continuously improve work environment/processes (Performance Improvement). Demonstrates a patient and family centered focus when considering/developing improvement solutions.
• Represents willingness/enthusiasm to create, embrace and facilitate change.
• Develops self and others; supports a learning environment; leads by example. Encourages patients and families to give feedback and suggestions for improvement.
• Develops working relationships critical to the organization including patients, families, coworkers, other departments, physicians/providers and community.
• Encourages others by providing recognition and support

Travel Requirements:

• Estimated Amount: - Travel required.