The Coordinator-Behavioral Health Utilization Management (BH-UMC) will review and monitor all patients admitted into psychiatry or substance abuse for appropriateness of admission according to nationally recognized criteria.
The Coordinator-Behavioral Health Utilization Management (BH-UMC) will review and monitor all patients admitted into psychiatry or substance abuse for appropriateness of admission according to nationally recognized criteria. The BH-UMC will monitor discharge plan, continued stay, provide clinical information to managed care plans or other intermediaries in order to secure certification status and reimbursement for the hospital. The BHUMC will collaborate with the physician, social worker and nursing to insure that discharge plan is implemented timely, communicated to health plan and executed within appropriate length of stay allowances. The BH-UMC will work under the direction of the Case Manager assigned to Behavioral Health in order to insure that all patients are reviewed and certified. The BH-UMC will collaborate and communicate with all members of the Behavioral Healthcare team to insure that patients designated for admission have all necessary documentation to meet admission criteria for reimbursement purposes. The BH-UMC will facilitate discharges and assist the discharge planning process by identifying delays/barriers to discharge.
Knowledge of Medicare, Medicaid, Managed Care and OASIS guidelines, medical necessity criteria pertaining to psychiatry and substance abuse.
Knowledge of federal and state regulatory guidelines governing Behavioral Health
Minimum of three (3) years experience specifically in Behavioral Health Utilization review and case management. Managed Care or Discharge Planning experience in Behavioral Health a plus.
Bachelors/Masters
BronxCare is the largest voluntary, not-for-profit health and teaching hospital system serving the South and Central Bronx, with 859 beds and more than 4,500 employees. Its two main hospital divisions, comprehensive psychiatric and chemical dependency programs, long-term care facility, and extensive outpatient network of 39 practices are providing the wide range of services needed by the community. BronxCare is now among the largest providers of outpatient services in New York City, with close to 750,000 visits annually. Its ER is among the largest in the nation with 127,000 visits annually.
In 2023, BronxCare received full accreditation from the Joint Commission, the leading accrediting authority for hospitals in the nation. Its medical school affiliation with the Icahn School of Medicine at Mount Sinai and clinical collaboration with the Mount Sinai Health System, as well as 16 accredited residency and fellowship programs, are strong indicators of excellence. BronxCare’s outpatient practices are also certified as a Level Three Patient-Centered Medical Home (the highest designation) by the National Committee for Quality Assurance (NCQA).
As an engine for positive change, BronxCare has infused more than $400 million into the Bronx economy, including a new Pediatric Specialty Center and Ophthalmology Practice, among numerous other capital projects. A new 33-bed Medical-Surgical Unit at the Concourse Hospital Division and 20-bed Adult Psychiatric Unit at the Fulton Hospital Division will increase inpatient capacity to 912 beds, further reinforcing BronxCare’s ability to address the significant needs of the Bronx community.
BronxCare is also modernizing its Inpatient Maternity and Labor and Delivery Units, as well as its Women’s Health Center and Neurology Suite, to improve the patient experience. Additionally, BronxCare’s Dr. Martin Luther King, Jr. Health Center Practice at 174th Street will be opening.
