Utilization Manager

1 month ago

Urbana, United States Carle Full time

Utilization Manager - Adolescent Psych Young Minds

+ Department: Adolescent Psych - IP YMC

+ Entity: Peoria Service Area

+ Job Category: Mental Health

+ Employment Type: Full - Time

+ Job ID: 46606

+ Experience Required: 3 - 5 Years

+ Education Required: Bachelors Degree

+ Shift: Day

+ Location: Peoria, IL

+ Usual Schedule: M-F 8a-4:30p

+ On Call Requirements: None

+ Work Location: Young Minds Center

+ Secondary Job Category: Allied Health

+ Weekend Requirements: None

+ Holiday Requirements: None

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Position Summary:

To provide utilization management services to the inpatient unit facilitating the delivery of appropriate, cost-effective, and clinically effective services across the continuum of care

Qualifications:

EDUCATIONAL REQUIREMENTS Bachelor's Degree in In psychology, social work or related field. EXPERIENCE REQUIREMENTS Minimum of 3 years of experience in behavioral health ADDITIONAL REQUIREMENTS

+ Use of usual and customary equipment used to perform essential functions of the position.

+ Work may occasionally require travel to other facilities/hospitals

+ Required to drive your own vehicle for business purposes

+ Shared office space for all or a portion of the workday

SKILLS AND KNOWLEDGE Writes, reads, comprehends, and speaks fluent English. Basic computer knowledge using word processing, spreadsheet, email, and web browser. Multicultural sensitivity Critical thinking skills using independent judgment in making decisions. Advanced reading, writing and oral skills Ability to utilize PC including, basic elements of Windows environment, keyboarding, work with mouse, and perform basic computer tasks with instruction.

Essential Functions:

+ Collaborates with the interdisciplinary team to facilitate placement of patients in the most appropriate level of care and ensure insurance requirements are met from initial contact through admission.* Reviews all admissions immediately following the admission and no later than the next business day after the admission to determine the appropriateness of the admission.* Discusses with the psychiatrist, any concerns regarding admissions related to the level of care the patient is receiving.* Applies admission, continued stay/transfer, and discharge criteria to each patient.* Reviews all patients' records a minimum of every two days to determine appropriateness of the level of care.* Monitors patient's payor requirements.* Works with the Patient Financial Services Department to ensure patients meet financial eligibility for treatment services. * Participates in interdisciplinary treatment conferences (clinical staffing) within 72 hours of admission and at least twice a week to review patient's progress, in order to report to payors and plan for discharge.* Maintains a working knowledge of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), the current Mental Health and Developmental Disabilities Code and the current Illinois Department of Human Services' Mental Health and Developmental Disabilities Confidentiality Act.* Maintains a working knowledge of psychotropic medication.* Maintains current knowledge of standard evidence-based treatments for major mental/emotional/behavioral diagnoses common to children, adolescents, adults, and senior adults.* Completes and submits documentation for medication prior authorizations

+ Works in conjunction with the interdisciplinary team to coordinate the development and implementation of the treatment and discharge plan for patient; and occasionally works in collaboration with the Behavioral Health Service Line management team to fulfill the visions of the service line and of Carle Health.* Maintains communication to ensure timely and comprehensive transmission of information throughout the continuum of care.* Coordinates the discharge planning process with the psychiatrist, primary nursing staff, mental health clinician, and discharge planner as soon after admission as is clinically appropriate.* Assists in referring patients in need of special placement such as nursing home, residential and supervised housing to the mental health clinician and assists in the process as needed.* Works with payors to maximize benefits in establishing outpatient services, case management, transportation, and other essential services* During emergencies and low patient census, functions as direct care staff when requested.* During times of high census, collaborates with Nurse Manager and /or Lead Nurse to provide direct services to patients.* Utilizes CPI methods to assist with aggressive/violent patients when it is necessary to protect himself/herself or others from harm

+ Assists in quality improvement processes.* Collects data on care factors (including outcome measurements), assists in the analysis, generates regular reports as requested.* Assists in completing chart reviews in a timely manner, as assigned * Participates in the design and revisions of documentation forms and other quality improvement processes to ensure attainment of outcomes in a cost-effective manner.* Assists the ordering physician in determining the necessity of service, impact of services on problems leading to admission, alternative/more cost-effective services, or postponing service until after discharge-collects data on physician patterns as requested.* Assists in identifying and decreasing unnecessary ancillary services.* Facilitates expedient physician and other responses to third party payors or reviewers' quality issues.* Participates on unit council and contributes to quality improvement reviews and feedback.

+ Identifies and utilizes opportunities to assure that the appropriate maximum allowable.

TrilliumPlace

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.

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