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Intake Nurse and Utilization Specialist

2 months ago

Athens, United States Starr Regional Medical Center Full time
Job Description

Starr Regional Medical Center is currently seeking talent to fill the position of Intake Nurse and Utilization Specialist for our GeroPsych Department. This job is permanent, full-time.    
 

Core competencies include, but are not limited to the following: 

  • Ability to work independently in a fast-paced hospital environment. 

  • Ability to have flexible hours to meet business (hospital and patient) needs. 

  • Demonstrates basic understanding of legal issues associated with assessment/admission for Voluntary vs. Involuntary status, i.e. 72 Hour Hold, EMTALA and Mental Inquest Warrant processes as defined in state of practice. 

  • Ability to cultivate and maintain relationships with internal and external customers as well as maintains patient/family confidentiality and provides sensitive, respectful, and compassionate customer service at all times. 

  • Ability to work with adults and geriatric patients (18 and over) experiencing mental illness and acute psychiatric crisis. 

  • Capable of reviewing clinical documentation for emergency departments and identifying the symptoms that qualify of inpatient hospitalization. 

  • Knowledge of Diagnostic and Statistical Manual of Mental Disorder V (DSM V) or most current version. 

  • Understanding of mental illness and stages of development. 

  • Ability to present clinical findings to attending psychiatrist and charge nurse. 

  • Ability to coordinate the transfer of patients from other facilities. 

  • Documents payer interactions on assigned cases regarding authorizations with managed care review agencies, in the manner required by the Lifepoint facilities. 

  • Conducts review for appropriate utilization of services from admission through discharge and evaluates quality of care provided. Ensures documentation of all patient review records according to regulatory, legal and case coordination requirements and acts proactively to see that hospital resources are used appropriately. 

  • Performs reviews for third party payors in an accurate and timely manner. 

  • Communicates daily with physicians, hospital staff, family, community care providers, and patients to facilitate coordination of care. Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, and legal issues that affect patients and providers of care.