Care Manager Utilization Review

Riverside Health System • Hampton, VA

16d

About The Position

This position must demonstrate by education and/or training a background in the assessment and treatment of adolescents and adults seeking psychiatric and/or chemical dependency treatment. The position works under the supervision of the Manager/Director and is responsible for working in collaboration with the healthcare team to coordinate the care and service to patients across the continuum of care. The care manager promotes effective utilization and monitoring of healthcare resources and assumes a leadership role with the interdisciplinary team to achieve optimal quality, clinical, and resource outcomes. Performs and completes all medical record documentation and other written assignments (CM Screening Form) outlined in the department/hospital policy. The Care Manager serves as the court services liaison and is part of the multidisciplinary treatment team. This position is responsible for discharge planning to ensure aftercare plans are appropriate to patient goals. All discharge plans are in accordance with standards of excellence established by Riverside Health System, and facility goals and strategic plans. Utilizes national hospital based ACMA scope of Services and Standards of Practice as foundation of Care Management. Care Managers complete annual competencies to ensure care is evidence based. Non-Registered Nurse and Non-Social Work staff are required to convey discharge plans with supervisor and entire interdisciplinary team members.

Requirements

• Bachelors Degree, Counseling, Psychology, Social Work, Sociology, or related field (Required)
• 1 year Clinical Experience (Required)
• CPR/BLS Certification - American Heart Association/American Red Cross/American Safety and Health Institute (AHA/ARC) within 30 Days(Required)
• First Aid - American Heart Association/American Red Cross/American Safety and Health Institute (AHA/ARC) within 30 Days(Required)

Nice To Haves

• Masters Degree, Healthcare related field, such as MSW, MS, MA, M.ED, counseling, Psychology, Social Work or related field (Preferred)
• ACMA/CCM Certification Preferred
• Licensed Clinical Social Worker (LCSW) - Virginia Department of Health Professions (VDHP) (Preferred)
• Licensed Masters Social Worker (LMSW) - Virginia Department of Health Professions (VDHP) (Preferred)
• Licensed Professional Counselor (LPC) - Virginia Department of Health Professions (VDHP) (Preferred)
• Marriage and Family Therapist - American Association for Marriage and Family Therapy (Preferred)
• Resident in Counseling - Virginia Department of Health Professions (VDHP) (Preferred)
• Resident in Marriage and Family Therapy (RMFT) - Virginia Department of Health Professions (VDHP) (Preferred)

Responsibilities

• Takes on additional work and/or assists others in the completion of their work during periods of high census and heavy workloads.
• Provides quality and clinically sound care coordination and discharge planning reflective of the patient’s status and age, treatment needs, as described in the policy and procedure guide.
• Actively coordinates and documents patient care with referral and payor sources.
• Demonstrates excellent customer service in person and via telephone, projecting a professional image at all times.
• Serves as the initial point of contact for patients, families, and referral and assures they are active participants in the treatment planning process.
• Identifies process improvement opportunities related to efficiency, appropriateness, productivity and/or coordination of activities/services with other departments and personnel.
• Uses non-patient care time in productive ways that benefit patients, residents, department, and facility.
• Collaborates as an active member of the interdisciplinary treatment team.
• Communicates patient, resident, family needs to physicians accurately and completely.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees