PIW is committed to improving the behavioral health care within our community by going beyond the traditional. We will continue to develop diverse and dynamic treatment programs and establish partnerships with others to understand and serve people where they live. Together we will build upon our strengths and human spirit to create a different future.
Responsible for managing all utilization case management activities for assigned cases from admission through discharge to final disposition of case, including appeals in accordance with hospital Utilization Review Plan for patient population from ages 11+. Provides support to Program and treatment team in focus and documentation of medical necessity and timely discharge planning. Maintains data on UCM activities and generates required reports, logs, and files as requested. Internally, the incumbent will interface with hospital management, staff, and patients. Externally, the incumbent will interface with licensing and accrediting agencies, managed care companies, family members, and healthcare treatment agencies.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Tracks new admissions or transfers to assigned area and is responsible for knowing and following through with certification requirements from admission through discharge. Serves as liaison to on-site external reviewers.
Uses Midas for recording reviews and tracking denials. Adds to Midas databases as needed.
Teaches staff to document medical necessity through in-services or individual meetings. Monitors quality of records and notifies staff and program director of problems. Available to program director to develop plan for improvement as needed.
Supports and guides treatment planning as needed. Continues to bring to staff awareness the need for documentation to flow from and correlate with treatment plan.
Informs department director of changes in managed care companies. Maintains awareness of unique status to propose out of plan benefits or to open the door to increase hospital's opportunity to provide services to a larger group.
Works appropriately and professionally with all staff and demonstrates a supportive attitude toward the goals of the hospital. Makes recommendations for the hospital based on identified trends.
Arranges schedule in consideration of needs of the department, participates in arranging coverage for planned absences and demonstrates a supportive attitude toward the goals of the department.