Case Manager Ii, Acute Psychiatric

2 weeks ago

Berkeley, United States Sutter Health Full time

**Organization**:
ABSMC-Alta Bates Herrick Campus

**Position Overview**:
The Psychiatric Case Manager coordinates the care of patients through the provision of clinical case management to assure that patients are being treated at the appropriate level of care and that the admission, treatment and discharge are well coordinated. This is accomplished through close collaboration with the patient, family, physician, treatment team, external case managers, referring therapists, outpatient clinic, and payor. Preferred experience includes: experience working with severely mentally ill patients, competency in completing psychosocial assessments, advanced skills and knowledge in discharge and safety planning, working knowledge of current reimbursement requirements (including Medicare, MediCal, private contracting), excellent communication skills, both written and verbal, ability to work with a broad spectrum of health care professionals, assertive and creative approach to solving complex systems problems, and ability to work under pressure and deal with change.

The Psychiatric Case Manager coordinates the care of patients through the provision of clinical case management to assure that patients are being treated at the appropriate level of care and that the admission, treatment and discharge are well coordinated. This is accomplished through close collaboration with the patient, family, physician, treatment team, external case managers, referring therapists, outpatient clinic, and payor. Preferred experience includes: experience working with severely mentally ill patients, competency in completing psychosocial assessments, advanced skills and knowledge in discharge and safety planning, working knowledge of current reimbursement requirements (including Medicare, MediCal, private contracting), excellent communication skills, both written and verbal, ability to work with a broad spectrum of health care professionals, assertive and creative approach to solving complex systems problems, and ability to work under pressure and deal with change.

This position coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. This position oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. This position strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.
- These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)._

**JOB ACCOUNTABILITIES**:
Patient Initial and Concurrent Screening.
- Reviews initial physician admission care plan. Gathers additional medical, psychosocial and financial information from the patient/family interview, medical record assessment, physicians and other health care providers. Determines moderate or high risk level for readmission. Conducts a screening for ancillary supportive services.
- Functionally supervises and actively leads the health care team in developing comprehensive, cost-effective care coordination plans that meet the clinical needs of our patients. Performs cost benefit analysis of care options.
- Formulates a transition plan after reviewing available/appropriate care options and obtaining input from the patient/family and physician, health care team, payers and community based support services.
- Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.
- Directs and oversees the Assistants to interview patient/family and determine preferences for post -acute care services.

Utilization Management.
- Completes initial InterQual review screening upon admission for all patients placed in a hospital bed and documents, either inpatient or Observation (OBS) status.
- Performs InterQual continued stay and discharge planning reviews.
- Reviews medical record daily to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment.
- Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services.
- Monitors Length of Stay (LOS) and outliers requiring additional resources and/or focus and reports to management.
- Collaborates with financial counselor for d

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