The Behavioral Health Care Manager integrates the care of the individual within Behavioral Health Services. The Behavioral Care Manager will function within a multidisciplinary team, offer some components of therapeutic modalities and will be a liaison for the patient and other services. Those services will include, but are not limited to discharge placement referrals, interdepartmental referrals and reimbursement options for patients. The care coordinator serves as a central source of communication for the patient and their support systems. A Behavioral Health Care Manager may serve in one of two different tasks: utilization management and care coordination. Primary task is assigned via manager of care management. All members of this team will work together to ensure the patient’s care is seamless.
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Utilization Management:
Addresses and monitors length of stay issues and level of care changes for compliance
Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization of resources and pursues denials of payment and referrals in a timely, legible manner.
Collects appropriate data, trends, analyzes and reports on patterns of care, possible avoidable delays in transition, variance from pathways and resource utilization
Care Coordination/ Discharge Planning:
Assesses the individual’s health status, including clinical conditions, support systems and resources to identify needs and make referrals to appropriate multi-disciplinary services.
Monitors and coordinates an interdisciplinary plan of care in partnership with the individual and their support services for needs and services across the health care continuum and for transition through the levels and locations of care.
Assumes accountability for the development and implementation of an effective discharge plan for complex-care patients. Works with internal and external resources to coordinate a timely and safe transition of patient to the appropriate level of care.
Documents the case management plan to include: clinical needs, barriers to quality care, effective utilization of resources and pursues referrals in timely manner.
Revenue Cycle:
Demonstrates a working knowledge of financial and reimbursement processes to facilitate medical cost management, including best practices, effective utilization of resources, linking clinical and financial aspects of care, and access to care and level of care.
Serves as a resource and educator to patient, family, staff and physicians regarding financial aspects of individual patient’s resources which may affect the transition of patients through the healthcare system.
Provides education for the individual and family and for the team regarding benefits, utilization of resources, levels of care, and expectations of the transition process throughout settings across the healthcare continuum. Facilitates empowerment of the patient and family in self-management and health care decision-making.
Education: Required to have Bachelor of Art/Science Degree in a health care/human services related field or RN. Master’s degree in a healthcare/human services related field is highly preferred.
Experience: Required to have two years of clinical experience in focused areas working with multidisciplinary teams. Licensure appropriate to population served required.
License(s)/Certification(s): Valid driver’s license when driving any vehicle for work-related reasons.
Knowledge/Skills/Abilities: Writes, reads, comprehends, and speaks fluent English. Basic computer knowledge using word processing, spreadsheet, email and web browser.
Other: Use of usual and customary equipment used to perform essential functions of the position.
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