UnityPoint Health

  • Care Manager

    Requisition ID
    2018-48030
    Category
    Nursing
    Location
    US-IL-Rock Island
    Address
    3416 Blackhawk Rd
    Affiliate
    6020 UnityPoint Health QC Trinity
    City
    Rock Island
    Department
    Prec Carve Out
    State
    IL
    FTE
    1.0
    FLSA
    Exempt
    Scheduled Hours/Shift
    8am-5pm m-f
    Work Type (Portal Searching)
    Full Time Benefits
  • Overview

    UnityPoint Health- Trinity has an exciting opportunity for a Care Manager to join our growing behavioral health care utilization management team.  We are proud to be one of the most experienced mental health care providers, with a long tradition of caring for our community. While being a leader in compassionate care is important, we believe it's equally important to be a leader in the behavioral health industry. No health care system is complete without a behavioral health division. The recent advances in behavioral health have given way to richer, deeper, treatment programs that put the patient at the center of each care plan. Since our founding, the Robert Young Center has championed mental health care advocacy, offering services under UnityPoint Health - Trinity.  

     

    In this role, you will be responsible for providing triage and care management for enrollees, responsible for utilization management relationships and provider relations. This position helps to coordinate, plan and evaluate procedures in the delivery of care management, while meeting accreditation standards, under the direction of the Director of Managed Care.

    Responsibilities

    TECHNICAL/ADMINISTRATIVE/CLINICAL: Demonstrates competence in recognizing and responding to patient's physical, mental, emotional, and developmental needs. Demonstrates competence in the skills, processes, procedures and equipment necessary to carry out assigned duties as identified below.

     

    Monitors the efficient operation of care management by working with the health care team, to maximize quality patient-centered care.

    Provides clinical care for the enrollees of Precedence by:

    • Providing care management to designated enrollees. Assuring that all enrollees receive clinically sound triage/ referral and ongoing care management services for behavioral health needs.
    • Provide documentation of enrollee contacts and clinical care and as it occurs.
    • Provides documentation of professional contacts/ provider relations as it occures.           
    • Attending regular and periodic staffings to review progress and changes in level of care.
    • Consulting with the medical director on all high-risk cases.
    • Serves as a professional resource for health team staff, keeping current with clinical developments.
    • Maintains 100% compliance with the laws, standards, rules and regulations of regulatory agencies, including but not limited to:
      • URAC
      • Illinois Department of Insurance
    • Accepts responsibility for compliance with policies and procedures.
    • Displays positive attitude towards employer, fellow heath care team, enrollees, utilization staffs, health plan and providers.
    • Builds personal accountability. Informs Director of Managed Care of problems or potential problems in the department in a timely manner.
    • Effectively resolves conflict between needs and requirements of the organization.
    • Recommend methods to improve the efficiency of utilization management.
    • Develops high risk program
    • Acts as a liaison to utilization staffs/providers and program directors.  This includes annual face to face visits.
    • Coordination and participation in the quarterly conference calls with each affiliate.
    • Builds relationships with utilization management staffs and providers to meet member needs.

    Assists the Director of Managed Care in efficient operation of the department by overseeing care management personnel and collaboration of care.

    • Evaluates and recommends equipment and supply needs.
    • Acts as a liaison with care team members
    • Establishes rapport with enrollees and providers to identify potential problems early on and take action to resolve problems. Notifies Director of management when appropriate.
    • Assist Director of Managed Care in developing and implementing policies, protocols and program in the department.
    • Keep utilization management contacts for hospitals and programs updated at a minimum every 6 months.
    •  Keep facility services that are available to enrollees updated at a minimum every 6 months.

     Coordinate Provider Relations.

    • Keep track of provider application, crenditling process and contracting.
    • Keep providers updated in VisonWorks.
    • Conduct provider office/record audits.

    Other duties as assigned.

    Qualifications

    EDUCATION, TRAINING & EXPERIENCE: BSN preferred or MSW required. Experience as a Care Manager in medical/ behavioral health care utilization management desired but not required.

     

    LICENSES, REGISTRATIONS AND CERTIFICATIONS:  Licensed behavioral health clinician, medical or behavioral health nurse with a  minimum of 5 years experience post license. Must be licensed in the  State(s) they work in. With a scope of practice that is relevant to the clinical area(s)  for clinical reviews.

          

    KNOWLEDGE, ABILITIES & SKILLS: Knowledge of behavioral health care services.  Good knowledge of best practices. Ability to problem solve; to plan, organize and direct care management activities; ability to communicate effectively, orally, and in writing. Good knowledge of computer skills. Knowledge of utilization review & discharge planning process desired.

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