LPN Utilization Manager

1. Promote a safe, cooperative and professional health care environment to ensure optimum patient care (as per HR Policy 113c).

2. Adheres to all hospital policies, procedures, rules and regulations, including but not limited to, absenteeism, ETIME, cellular telephone usage, dress code and rules of conduct.

3. Makes Customer Service a priority, treating customers (patients, visitors, and co-workers) in a professional manner exercising courtesy and tact. Effectively communicates with patients and others about SBH services in their area(s) of expertise or responsibility and ensures that concerns, questions or issues reach the right person(s) in SBH in a timely fashion.

4. Within 24 hours of admission, initiates discharge planning by assessing the patient's needs and documenting the assessment on patient's chart.

5. Ensures that the interdisciplinary care planning and the discharge plan are consistent with the patient's clinical course, continuing care needs and covered services.

6. Using established criteria, including Interqual, CMS, OASAS (LOCADTR) and others, reviews medical necessity for appropriateness of admission and appropriate use of resources.

7. Obtain from 3rd party payor: certification due to patient status change; and, in coordination with Social Worker as applicable, information needed for discharge or placement, as appropriate.

8. Ensures that all critical elements of the plan of care, which are communicated to the patient and family are documented on the care plan.

9. Coordinates discharge teaching with Nursing Department and other departments as applicable.

10. Consults with physicians, nursing staff and staff in ancillary departments to eliminate barriers to efficient delivery of care in the appropriate setting.

11. Discusses with attending physicians and counselors, the appropriateness of resource utilization, consultations and treatment plan.

12. With assistance of Case Management Denials Manager, involved in the concurrent denial appeal process (if any), engaging managed care organizations and other review agents.

13. Ensures that chart documentation supports the need for continued hospitalization.

14. In coordination with counselor and discharging nurse, ensures that patient follow up appointments are made prior to departure.

15. As applicable, interviews patient and/or family to obtain psychosocial information and assess the patient's functioning relative to safety and/or discharge planning needs. Collaborates with the addiction counselor as necessary.

16. Documents all work activity in the patient's medical chart in accordance with departmental and regulatory guidelines.

17. Work with the Social Worker to secure authorization for patients needs new placement..

18. In coordination with the counselor, serves as patient advocate with 3rd party payers to obtain applicable services within patient's benefits plan.

19. Performs other departmental tasks as requested and directed.

Performs the above listed functions and services

1. Education Required - Graduate from a recognized Nursing School or College, Evidence of continuing education courses, conferences or seminars.

1. License(s) Required - Current New York State LPN License

1. Experience/Skills Required - 3-5 years clinical nursing experience, preferably in an acute care hospital. In addition staff are expected to: engage with patient and/or family members with respect to cultural differences and sensitivity to individuality; maintain clinical competency and current knowledge of regulatory and payor requirements to carry out job responsibilities; maintain a calm, rational professional demeanor when dealing with others, even in situations involving conflict or crisis; and employee must have a high degree of skill in all oral & written communication and personal interactions.