This position is responsible for all aspects of insurance utilization review management including but not limited to insurance verification/authorization/appeals/retros/denials/ peer to peer review coordination, discharge planning, involuntary commitment proceedings coordination, and other duties otherwise assigned.
- Care - Provide the best possible patient care
o Educates patient and families on signs and symptoms of illness to prevent re-hospitalization and improve disease management skills.
o Provides assessments, treatments and case management to patients and families.
o Participates in discharge planning, arranges for follow up care and develops mechanisms for exchange of appropriate information with sources outside the hospital.
- Compliance - Ensure the program operates within all regulations
o Maintains performance improvement activities within the department and participates in performance improvement activities.
o Responsible for all insurance verification/authorizations/appeals/retros/denials/peer to peer review coordination.
o Initiates internal utilization review tracking system.
o Active participant in the hospital Utilization Review committees.
- Community - Become a wonderful addition to your local community
o Coordinates involuntary commitment proceedings.
o Serves as a resource person to healthcare professionals concerning psycho-social problems and community resources.
- Associate Degree, or higher, in Social Work or Nursing License required
- Two or more years of previous experience in all aspects of social service or nursing with an emphasis in psychiatric work.
- BLS will be provided
- Handle with Care training will be provided
- Basic computer knowledge
- Strong interpersonal skills
In clinical duties, will be exposed to communicable disease, blood, and body fluids. Exposure to injury from patients or equipment. Realizing there are unavoidable environmental hazards, the employee must assume responsibility for knowledge of protocols and policies relevant to these hazards. Utilized appropriate protective attire that will be provided in each area.
Ability to handle heavy materials or patients. Physical demands greater than moderate may require knowledge of use of appropriate equipment. Frequent bending, lifting and pulling require proper use of good body mechanics. Must be able to communicate effectively with patients, staff physicians and visitors displaying a smile and maintaining a pleasant attitude. This job includes close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Also, the ability to communicate by phone is important.
This position has no direct reports.
Founded in 2003 and based in Nashville, TN, Psychiatric Medical Care (PMC) is a leading behavioral healthcare management company focused on addressing the needs of rural and underserved communities. Operating in more than 25 states, the company manages both inpatient psychiatry units and intensive outpatient psychiatry programs within hospitals. PMC also provides telepsychiatry services across a variety of clinical settings. The company's programs provide evaluation and treatment for patients suffering from behavioral health issues including depression, anxiety, PTSD, and other mood and cognitive disorders. For more information, visit www.psychmc.com