RN Care Manager, Behavioral Health

Position Summary

Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patient most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next appropriate level of care.

Responsibilities

• Initially and concurrently assesses all patients within assigned population to include, but not limited to :

o Accurate medical necessity screening and submission for Physician Advisor review

o Care coordination that includes admitting diagnosis / medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special / personal needs, and other relevant information.

o Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of InterQual guidelines.

o Leading and facilitating multi-disciplinary patient care conferences

o Managing concurrent disputes

o Making appropriate referrals to other departments

o Identifying and referring complex patients to Social Work Services

o Communicating with patients and families about the plan of care

o Leading and facilitating Complex Case Review

o Identification and documentation of potentially avoidable days

o Identification and reporting over and underutilization

o Utilization Management supporting medical necessity and denial prevention

o Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction

o Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and appropriate level

of care

o Education provided to physicians, patients, families, and caregivers.

Qualifications

Education / Training

Licensure / Certification

Experience

Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care.