POSITION SUMMARY:

This position is responsible for maximizing access to inpatient behavioral health care and patient movement for the Department of Behavioral Health. Admissions for our Inpatient Behavioral Health beds require the ability to form relationships with area hospitals, emergency rooms, nursing homes and providers, timely and efficient responses to requests for beds, coordination with medical staff, and the ability to present cases concisely while covering important clinical detail.  This position works in collaboration with Director of CAT, Nurse Managers, Crisis Services, and Utilization Review. Responsible for patient movement across the system. Assists with verification of benefits, and prior authorization for services to ensure payment with perspective insurance companies.  Develops a working knowledge of the various payers’ admission criteria to ensure that the requirements for pre-certification are met.  Works with prospective patients, families, and referring professionals.  Works to maximize access to services across the inpatient BH service line.  Provides extraordinary customer experience, understands needs of callers and breadth of service in our system of care. Has a high level of understanding of available resources within the Behavioral Health continuum of care locally, regionally, and statewide.

 

EDUCATION/CERTIFICATION:

Master’s Degree and licensed/certified in a Behavioral Health field is required.

 

EXPERIENCE:

Minimum of ten (10) years of experience in the Behavioral Health field with Utilization Review required. Must have experience in caring for those with mental health, substance use, and co-occurring disorders. Requires experience with benefit verification, eligibility, pre-authorizations, and admission criteria.

 

COMPETENCIES:

Must have excellent verbal and written communication skills to effectively communicate with and be responsive to medical staff, referral sources, patients, family, and a multitude of other customers who interface with areas of responsibility. Requires experience working with and understanding hospital-based inpatient behavioral health care. Must have experience working with managed care and understanding of prior authorizations and utilization review. Must be familiar with requirements to meet hospital level of care, including basic symptomology, required labs, importance of obtaining medication reconciliations, and accepting appropriate insurance plans.

 

ESSENTIAL DUTIES and RESPONSIBILITIES:

Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job.  They are intended to be accurate reflections of the principal duties and responsibilities of this position.  These responsibilities and competencies listed below may change from time to time.

 

Coordinate admission and transfer between levels of care within the facility. Communicate projected admissions to designated internal representatives in a timely manner. Maintains optimal census across all units. Establishes positive working relationships with community referral resources to increase admissions to behavioral health from surrounding hospitals. Perform insurance benefit verifications and prior authorization for admission. Ensure all medical admission documentation is gathered from external sources prior to patient admission. Assist crisis services with prior authorization when time allows to facilitate timely patient throughput. Review clinical data and determine appropriate level of care for patient after consulting with the attending physician. Completes an intake form, documenting patient’s clinical information and disseminates to the interdisciplinary treatment team. Contacts Utilization Review clinician with authorization and follow up reviews. Assists crisis services with referring outside of system to find appropriate beds when time allows. Understands the balance between service area admissions and outside admissions in order to maximize provision of care for behavioral health patients.