Job Description

Location: St. Luke's Behavioral Health Center
Posted Date: 5/4/2022

Validates the medical necessity of admission and ongoing services of patients at St. Luke’s Behavioral Health Center and verifies or obtains authorization from third party payors.

Utilizes InterQual criteria for admission and continued stay reviews.

Continuously collects data about the behavioral healthcare status of the patient in a systematic way to determine the need and type of care and treatment to be provided, and the need for further assessment.

Identifies various levels of treatment available for the patient and works closely with the multidisciplinary team to coordinate/evaluate continued care and services and also advocate for appropriate discharge planning (including next level of care). Obtains authorization for next level of treatment when appropriate.

Identifies St. Luke’s Behavioral Health Programs, individual providers and community resources, and documents options in medical record.

She/he is accountable to problem solve for the care of the patient and to initiate immediate, effective action to maintain patient safety.

Responsible to meet Medicare/Medicaid regulatory requirements related to the provision of services for inpatient and outpatient mental health treatment.

Interfaces with external health-care professionals and providers to coordinate patient movement to a less restrictive level of care and ensures continuity of care.

Completes utilization documentation as required (CON/RON/Payor forms and CM notes). Ensures reimbursement from third party payors through the appeal process (completes appeal letters).

Completes CMS form 100% of the time and places on the Medical Record ensuring that physician signs, dates and includes time the CMS form is signed.

II. Job Relationships:

Works with other departments as a team member. Is motivated to assist in ways of improving the Meds to Beds program.

Recognizes the dignity of each person and shows respect for one another. Works to resolve concerns and complaints promptly and effectively.

Maintains a collaborative relationship with all payors, hospital, medical and leadership staff.

Demonstrates an ability to be flexible, organized and function under stressful/emergency situations.

Communicates with physicians/director/charge nurse/co-workers, as appropriate about changes in patient’s clinical condition including results of assessment and treatment modalities.

Serves as a resource to all patients and health care team.

III. Authority:

To problem solve patient care issues and initiate resolution through contact with chain of command.

IV. A. Responsibilities/Essential Functions:

Follows all safety and infection prevention guidelines.

Implements hospital policies established by St. Luke’s Behavioral Health Center.

Keeps director and management apprised of administrative and clinical issues.

Demonstrates leadership skills oriented towards quality care delivered efficiently with appropriate utilization contributing to the overall smooth operation of the department and organization.

Participates in performance improvement activities.

Demonstrates an ability to be flexible, organized and function under stressful/emergency situations.

Performs related duties as directed by the Director of Case Management.

V. Reporting Requirements:

Reports to the Director of Case Management.

Application Instructions

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