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Description

PeaceHealth is seeking a RN Admissions/Utilization Behavioral Health - Care Management for a Full Time, 1.00 FTE, Day position.

The salary range for this job opening at PeaceHealth is $44.34 – $80.37. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

This position is represented by a collective bargaining agreement. There may be more than one opening on this posting.

Hiring bonus and relocation assistance may be available.

Job Summary

Responsible for promoting effective utilization and monitoring of healthcare resources. This position will assume an informal leadership role with the multidisciplinary team to achieve optimal clinical, financial, and satisfaction outcomes.

Essential Functions

+ Acts as intermediary between the hospital and third party payors to ensure patients receive appropriate medically necessary inpatient psychiatric and medical services, so that the organization receives appropriate and optimal reimbursement. Understand and adhere to payer standards.

+ Obtain voluntary admission authorization. Monitor accepted admissions from off hours and follow-up on payer authorization.

+ Complete UR Admission review and Concurrent review processes. Ensure best use of limited inpatient resources by confirming accepted patients meet medical necessity criteria and will benefit from hospitalization.

+ Ensure that all disciplines document to payer standards and demonstrate the need for continued hospitalization.

+ Manage concurrent denials and some post discharge denials, submitting reconsideration clinical documentation. Assist provider in coordinating Peer to Peer with payer, as appropriate.

+ Collaborate with PFS, UR Leaders, Payer contracting to ensure efficient work process in obtaining authorizations.

+ Guide discussion with treatment team to improve quality, decrease cost and improve patient satisfaction. Document avoidable days.

+ Verify patients on Single Bed Certifications and oversee UR process related to SBC encounter.

+ ITA- monitor for change of status and notify payer.

+ Provide admission support to Behavioral Health unit/ED/SECU as needed. Assist MSW with initial assessments, as appropriate.

+ Ensure delivery of appropriate Medicare Notices.

+ Assist MSW CM with medical transitions of care discharge planning such as medication pre-authorization, referrals to home health, procurement of DMW, SNF referrals, appt scheduling etc.

+ Performs other duties as assigned.

Qualifications

Education

+ Required: Degree from an Accredited School of Nursing

+ Preferred: Bachelor of Science in Nursing

Experience

+ Strongly Preferred: Prior admission coordination or care management experience.

+ Strongly Preferred: Working knowledge of psychiatric diagnostics.

+ Preferred: Third party reimbursement knowledge.

+ Preferred: Utilization Review experience, someone who can talk to providers.

Credentials

+ Required: Registered Nurse in state of practice

+ Preferred: Psychiatric/Mental Health Clinical Nurse Specialist

Skills

+ Strong psychiatric nursing background. (Required)

+ Must possess strong medical and psychiatric assessment, problem solving and prioritization skills and working knowledge of DSM 5 Revised. (Required)

+ Excellent interpersonal skills required; must be professional in working closely with all customers such as referral sources, physicians, staff, patients and families. (Required)

+ Good organizational skills and demonstrated ability to multi-task in a fast-paced environment. (Required)

+ Ability to take direction from multiple sources and manage competing demands effectively. (Required)

+ Requires excellent communication skills with the ability to communicate with people who have disabling conditions, or who have cultural differences, as well as clinicians less proficient with the needs of people with behavior issues. (Required)

+ Proficient use of computers including MS Office applications and other applicable software applications. (Required)

Working Conditions

Lifting

+ Consistently operates computer and other office equipment.

+ Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

+ Sedentary work.

Environmental Conditions

+ Predominantly operates in an office environment.

+ Some time spent on site in medical/hospital setting.

Mental/Visual

+ Ability to communicate and exchange accurate information.

+ The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility (https://www.thecaregiver.org/wp-content/uploads/2017/05/PeaceHealth-Statement-of-Commitment-to-Diversity-and-Inclusion-vFINAL.pdf) .

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.

REQNUMBER: 122345