Behavioral Health Complex Quality Management Coordinator

Hurley Medical Center•Flint, MI

23d

About The Position

This registered nurse role focuses on enhancing patient outcomes and service delivery within the inpatient complex. Key responsibilities include ensuring psychiatric health services on our adult and adolescent psychiatric units meet established quality and compliance standards and the behavioral health patient experience throughout the continuum. This role also involves collecting, analyzing, and reporting on quality metrics, performance data and patient feedback to identify trends and areas for improvement. Works independently and incorporates positive patient experience tools and practices into their daily workflows. Performs all job duties and responsibilities in a courteous and customer- focused manner according to the Hurley Family Standards of Behavior. SUPERVISION RECEIVED : Works under the direct supervision of the Administrator for Behavioral Health or designee who assigns work and reviews for effectiveness and conformance with policies and procedures.

Requirements

Licensed as a Registered Nurse from the State of Michigan
3 years of clinical experience as a registered nurse in an acute hospital facility with at least 18 months experience with behavior health preferred.
Working knowledge of utilization management and/ or experience preferred.
Current knowledge of governing regulations, third party payer utilization, quality mandates, reimbursement requirements, and standards associated with behavior health utilization review and management
Ability to work independently, set priorities, organize work, and make decisions in accordance with established policies and procedures while maintaining flexibility
Ability to compile, analyze, and evaluate data and prepare accurate reports from such data

Responsibilities

Competently perform, as needed, the job duties and responsibilities of the Behavioral Health Admissions Liaison and the Behavioral Health Utilization Review Nurse.
Collaborate with the Behavioral Health Admission Liaison and the respective Behavioral Health Nursing Units regarding admissions.
Develop and implement strategies to improve the patient care experience.
Assist with quality improvement projects as needed.
Assist with ensuring thresholds for the patient experience survey are being met.
Analyze the results, assist with data submissions and develop ways to improve the patient experience.
Prepare for the upcoming implementation of the inpatient psychiatric facility (IPF) patient assessment instrument (PAI) and be the designated clinician to submit the instrument data to CMS.
Work with IT (EMR) to improve data capture and improve communication and efficiencies.
Monitor and evaluate compliance with external agency standards relative to quality and patient safety activities.
Participate in the collection and analysis of quality and patient safety data.
Work with the Behavioral Health Admissions Liaison to develop and strengthen referral sources.
Utilize the EMR system efficiently and effectively and provide sufficient and clear documentation of all actions taken.
Complete and monitor patient authorization activities as required by various payers
Utilize all available tools to complete insurance authorization or referral duties in the most effective and efficient manner. Examples include Epic, Health Nautica, Right Fax, various insurance websites and payer portals, enterprise payer matrix, and any other software or application needed to complete the job successfully.
Ensure timely processing of timelines of third party insurance payers for prior authorizations and medical necessity justification purposes.
Work with Patient Access Department to verify patient information and insurance coverage, updates whenever necessary.