Job Description
Masters Level Care Manager - OP | Creekside Behavioral Health | Knoxville, Tennessee
About the Job:
PURPOSE STATEMENT:
The Care Manager is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge coordination and planning according to approved clinically valid criteria and meeting the daily deadlines to obtain authorizations and complete other pertinent processes.
Roles and Responsibilities:
ESSENTIAL FUNCTIONS:
- Analyzes client records to determine appropriateness of admission, treatment, and length of stay to comply with government and insurance company reimbursement policies. Ensures charting deficiencies are minimized and correctly timely by responsible personnel.
- Analyzes insurance, governmental and accrediting agency regulatory standards/requirements to determine criteria concerning admissions, treatment, and length of stay of clients.
- Reviews application for client admission and approves admission or refers case to utilization review committee for review and course of action when case fails to meet admission standards.
- Appeals all denials ensuring accuracy of information and effective coordination of correspondence.
- Compares client’s medical records to established criteria and confers with medical, clinical, and nursing personnel and other professional staff to determine appropriateness of treatment and length of stay. Communicates and coordinates information with business office to recognize and resolve potential payment issues.
- Abstracts data from records and maintains statistics.
- Determines client review dates according to established diagnostic criteria.
- Assists review committee in planning and holding mandated quality assurance reviews.
- Ensures each assigned client has a structured and clinically appropriate post hospitalization care plan.
- Liaisons to referral sources and support of continuation of care.
- Meets with assigned clients to ensure an individualized discharge plan is created and implemented.
- When clinically warranted, collaborates with family members and significant others for collaborative clinical information, communication, and discharge planning support.
- Schedules and attends treatment team meetings. Engages the client and significant others in the care planning process.
- Recommends effective treatment interventions and discusses/obtains orders from the attending psychiatrist for non-routine interventions.
- Minimizes deficient medical records and when identified, corrects as soon as practical.
- Maintains Utilization Review files in a neat, orderly, and confidential manner with special attention to security.
- Documents all client, family, and discharge planning contacts timely and completely in the medical record.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Master’s degree in social work, mental health, or a related field, or graduation from an accredited school of nursing required.
- One year’s experience with communication with external review organizations or comparable entities required. Direct clinical experience in a psychiatric or mental health setting preferred.
- Comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using the established hospital criteria.
- Ability to communicate professionally and effectively, orally, in person, and in writing, with multidisciplinary team members, managed care organizations and business office, providing needed information in a logical, concise manner using technical language that accurately describes client’s condition and need for hospitalization.
- Working knowledge of payor resources and financial planning.
- Knowledgeable of a wide range of community resources: financial, housing, legal, social/recreational, occupational, spiritual and support groups.
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- If RN or LPN, valid current RN or LPN license from the state or from a compact state, where applicable.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
- First aid may be required based on state or facility.
SUPERVISORY REQUIREMENTS:
This position is an Individual Contributor.
Why Creekside Behavioral Health-Creekside Behavioral Health offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Creekside Behavioral Health is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.
