The essential functions of this position include, but are not limited to: serving as care coordinator for patients in the Psychiatric Partial Hospitalization Program, establishing a therapeutic relationship with all patients. Facilitates maintenance of a therapeutic environment through general knowledge of patients’ therapy plans and reinforcement of desired behaviors; provides nursing care, assessment, support and education to patients in the program; participates in delivery of educational services to patients and their families and/or significant others; performs admission and discharge functions. Collaborates with the psychiatric interdisciplinary team to facilitate utilization management for the Psychiatric Partial Hospitalization Program. Provides pertinent clinical data to outside agencies as needed to assure compliance with their requirements. Other duties, which may be assigned |
Responsibilities:
20%) Coordinates UR activities with the Supervisor of Psychiatric Partial Hospitalization Program to maximize reimbursement for patients. Is familiar with CMH contracts and procedures to maximize reimbursement. Places calls/submits electronically to third party payers for initial authorizations and for continued stay reviews, including CMH programs. Documents all contacts with name, phone number, number of days authorized date of next review, and any comments.
(20%) Leadership responsibilities: Participates in interdisciplinary team meetings and provides essential information to team members. Provides support to the program supervisor and therapists. Participates in training activities as needed. |
Certifications and Licensures:
BLS: Basic Life Support within in 1 month of hire or transfer date.
RN: Registered Nurse
BSW preferred - At least one year psychiatric nursing experience
Associate's degree is required
BSN/MSN Preferred
OTHER DUTIES AND RESPONSIBILITIES
Reviews denials of coverage to assess if there is documentation to support an appeal, or to determine what needs to change in the documentation.
Assists Supervisor in writing appeals and submitting information to payers as needed.
Educates casual staff regarding documentation and facilitates compliance.
Collaborates with psychiatrist regarding discharge criteria or length of stay.
Prepares patients for discharge from admission through their length of stay.
Works with therapist and outside agencies for follow-up care concerns. Assists program supervisor with Quality Assurance/Quality Monitoring.
Attends Coordination of Care meetings.
Prepares for and attends Weekly Team Meetings.
Coordinates medical issues for patients with his/her Primary Care Physician.
Provides educational groups related to medication and healthy living. Sleep.
Diet – including topics such as shopping, meal plans, healthy eating habits, exercise and activity, stress management, etc. Participates in marketing program as time permits.
Assists in staffing marketing booth at fairs, seminars, etc..
Answers public inquiries about the program Complies with MyMichigan Medical Center Midland policies and procedures
Adheres to all policies and procedures related to employment, safety, program provision and operations.
Is familiar with the Michigan Mental Health Code as it relates to: recipient rights, confidentiality, abuse and neglect, and Duty to Warn.
MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft® Windows and other technology.
An employee may be required to participate in further learning opportunities offered by MyMichigan Health.
REQUIRED EXPERIENCE, TRAINING AND SKILLS
Licensed as a Registered Nurse in the State of Michigan. BSN/MSN Preferred.
BLS certification is required within one month of hire. Must follow MyMichigan Health bloodborne pathogen and TB testing as required Mandatory Occupational Safety and Health Administration (OSHA) training must be completed annually according to the Exposure Control Plan.
Mandatory Recipient Rights training within 30 days of hire and annually.
Mandatory conflict avoidance and physical management (CPI) within the first 30 days of hire and annually.
PREFERRED EXPERIENCE, TRAINING AND SKILLS
Previous utilization management experience is preferred. Must be proficient with computer skills and applications. Knowledge of data analysis is preferred. At least two years of recent clinical experience in psychiatric nursing.
PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS
Is regularly required to move freely about the unit and hospital. May be required to physically aid patients, including lifting. Overall vision is necessary, including color and depth perception, reading and close?up work and a peripheral field of vision. Overall dexterity is required, including handling, reaching, grasping, fingering and feeling. Hearing and speech are necessary, including on the phone as well as in person and faint sounds. Emotional stability is a must, due to frequent exposure to stressful situations; trauma, grief and death, public contact, decision making and high level of concentration. May be exposed to blood borne pathogens and other potentially infectious material. Able to work in latex environment. Able to wear personal protective equipment that may include latex materials or appropriate substitute |