Patient Care Coordinator - Behavioral Health UM, On Call, Talbot Administration Building

The Patient Care Coordinator - Behavioral Health Case Management is responsible for utilization review, discharge planning, case management, and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.

Essential Functions:

* Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.

* Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.

* Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., PHP, IOP, OP, or transfer to medical or other non BH unit as needed.

* Coordination of Care. Case managing patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.

* Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.

* Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.

* Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.

* Ability to clarify, review, interpret and advise regarding outpatient Specialty referral services and benefit eligibility status using established clinical guidelines applicable to referral processing management in accordance with Health Plan policies and procedures to ensure appropriate administration of benefits. Collaborate with MAPMG physicians, Network physicians and other members of the Health Care Team to ensure appropriate outpatient Specialty referral services are coordinated at the appropriate level of care.

* Performs other related duties as directed.

Basic Qualifications:

Experience

* Three (3) years of recent clinical evaluation of Behavioral Health patients and experience in acute hospital utilization management that must have included case management duties, and/or, utilization review, and/or discharge planning required.

Education

* High School Diploma or General Education Development (GED) required.

License, Certification, Registration

* MD RN License required.

* BLS (from American Heart Association) certification required.

Additional Requirements:

* New Hire: Successful completion of PCC Orientation and Assessment of Critical Skills. Passing score on inter-rater reliability. Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.

* Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.

* Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.

Preferred Qualifications:

* B.S.N. preferred.