• Assure clients/patients/residents meet care criteria from admission through discharge and patient care is delivered in the most cost-effective manner.
• Use pre-established guidelines with criteria, review initial clinical information and initiate admission certification with external review entities.
• Maintain knowledge of clinical information by concurrent review of documentation, participation in staffing, attending case conferences and collaborating with other members of the treatment team to maintain certification with external review entities.
• Monitor medical record documentation using knowledge of established guidelines to promote compliance and further ensure quality for retrospective review by external review entities.
• Make appropriate referrals to physician advisor as needed.
• Act as liaison with facility and MCO to assure that all aspects of treatment are fully documented.
• Assist in identifying other options for care when necessary.
• Assure a seamless flow of information between levels of care by collaborating with the admissions department, clinical and financial departments, and patient’s significant other/guardian to provide a smooth transition.
• Assure coordination of resources with other community services and agencies.
• In addition, may oversee daily operations of the team and assign staff as clinically warranted.

Experience

• 3 year(s): work in a behavioral health setting required

• Experience in case management and/or utilization review preferred
• Experience with the patient population served by the facility preferred

Education

• Bachelors or better in Social Work or related field

Skills

• Leadership
• Oral Communication
• Written Communication

Motivations

• Self-Starter: Inspired to perform without outside help
• Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals
• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)