Utilization Management Coordinator Jobs in Delaware

Position Summary:

Receives inquiry calls and assists the caller with scheduling a face-to-face assessment or provide triage to the appropriate community referral based on patient need. Assesses or ensures necessary assessment by a licensed, qualified mental health professional for patients who present for assessment. Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is provided either at the hospital or another appropriate provider in the community. Ensures appropriate screening of medical and behavioral emergency conditions. Completes all administrative processes of the admission for treatment including, as appropriate, the initial authorization of care with the insurance company/third-party payor.

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

• Demonstrates excellent phone skills including inquiry calls, explanation of assessment processes, scheduling appointments and successful closure of a call while avoiding phone therapy.
• States the procedure for managing a crisis call and identifies when to activate EMS services. Identifies safety and risk of each call.
• Documents all inquiry calls, completely and legibly, to include all applicable information on Call Worksheet.
• Makes appropriate referrals to community resources if not scheduling an assessment
• States the process and reasoning for all follow up calls either to confirm an assessment, inquire about no-show status, or rescheduling an assessment to include documentation reflecting same.
• Enters all inquiry calls into HCS with all data needed to further action or follow up
• Shows competency and understanding of the review of the medical screen; as appropriate, notifies the RN for additional review and action.
• States the working definition and procedure for managing medically and psychiatric emergencies according to EMTALA guidelines as well as hospital policies.
• Identifies and triages emergent patients and prioritizes care based on same.
• Completes the clinical screening and assessment tool (PASP) with concise, clear, and legible documentation.
• As applicable, identifies the need for additional screening for substance use, nutrition needs, functional needs, and abuse for children/adolescents, school and development screening.
• Demonstrates understanding of admission criteria for inpatient, partial hospitalization, intensive outpatient hospitalization and outpatient levels of care.
• Documents any special needs related to spiritual or cultural needs.
• Demonstrates a working knowledge of community mental health and substance use programs/referral to be offered for all patients not at imminent risk nor requiring services at a higher level of care as provided at the hospital.
• By demonstrating competency and thorough clinical understanding, ensures that each patient is seen by a physician or has had a consult by a physician to obtain treatment recommendations and disposition.
• Upon admission to a treatment program within the hospital, notifies the unit staff of the patients level of acuity, chief compliant and history of illness leading to admission, medical concerns and attending physician.
• Demonstrates understanding of all hospital required paperwork for admission and completion of admission packets for each department as applicable.
• Knowledge of state local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.
• Ensure correct information on EMTALA log to include all timelines and no blanks in documentation.
• Understands the ability to accurately maintain the bed board reconciliation for patient placement upon admission.
• Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the Utilization Management team for concurrent reviews.
• As applicable, contracts the managed care organization or third-party
• Demonstrates an ability to be flexible, organized and function well in stressful situations.
• Treats patients and their families with respect and dignity, ensures confidentiality of patients records.
• Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary.
• Ensures that documentation meets current standards and policies.
• Answers the telephone in a polite manner and communicates information to the appropriate staff/family member.
• Perform other duties as required

Safety (15% of performance review)

• Strives to create a safe, healing environment for patients and family members
• Follows all safety rules while on the job.
• Reports near misses, as well as errors and accidents promptly.
• Corrects minor safety hazards.
• Communicates with peers and management regarding any hazards identified in the workplace.
• Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
• Participates in quality projects, as assigned, and supports quality initiatives.
• Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

• Works well with others in a spirit of teamwork and cooperation.
• Responds willingly to colleagues and serves as an active part of the hospital team.
• Builds collaborative relationships with patients, families, staff, and physicians.
• The ability to retrieve, communicate, and present data and information both verbally and in writing as required
• Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
• Demonstrates adequate skills in all forms of communication.
• Adheres to the Standards of Behavior

Integrity (15% of performance review)

• Strives to always do the right thing for the patient, coworkers, and the hospital
• Adheres to established standards, policies, procedures, protocols, and laws.
• Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
• Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
• Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
• Exemplifies professionalism through good attendance and positive attitude, at all times.
• Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
• Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

• Demonstrates accountability for ensuring the highest quality patient care for patients.
• Willingness to be accepting of those in need, and to extend a helping hand
• Desire to go above and beyond for others
• Understanding and accepting of cultural diversity and differences

Education

• Required: Current unencumbered license in the state of employment as a LPC, LMFT, LISW, LSW, LCSW, LISW-S, LPCC, LPCC-S, or LPA..  CPR and hospital-selected de-escalation technique certification.
• Maintains education and development appropriate for position.

Experience

• Required: One to three years of experience in a behavioral health setting.
• Preferred: Previous assessment and evaluation experience in a behavioral health setting.