Behavioral Health Consultant LCSW

Grande Ronde Hospital•La Grande, OR

1d•Onsite

About The Position

The Hospital Case Manager provides comprehensive case management services to patients across the continuum of care within the hospital setting. The incumbent applies the nursing process and professional judgment to assess, plan, coordinate, implement, and evaluate patient care needs in collaboration with physicians, interdisciplinary teams, patients, and families. This role focuses on ensuring quality outcomes, efficient resource utilization, and continuity of care from admission through discharge and post-discharge planning, in accordance with regulations and hospital policies.

Requirements

Current, unrestricted Oregon license in a qualifying discipline required (e.g., Registered Nurse [RN], Licensed Clinical Social Worker [LCSW], Licensed Master Social Worker [LMSW], or other applicable healthcare professional license).
Bachelor’s degree in nursing, Social Work, or a related healthcare field required; master’s degree preferred.
Knowledge of Oregon state regulations, Medicare/Medicaid guidelines, commercial insurance processes, and managed care principles to ensure compliant and efficient patient care and discharge planning.
Knowledge of community-based resources, social determinants of health, and systems of care to support safe and effective patient transitions.
Knowledge of trauma-informed care, cultural competency, as well as principles of diversity, equity and inclusion.
Ability to perform thorough utilization reviews using evidence-based criteria (e.g., InterQual or MCG) and respond effectively to payer denials or authorization delays.
Ability to advocate for patient-centered, ethical, and culturally competent care while balancing regulatory, clinical, and payer requirements.
Ability to adapt to changing priorities, complex patient needs, and fluctuating caseloads in a dynamic hospital environment.
Ability to organize and prioritize multiple tasks, coordinate care across departments, and work collaboratively within interdisciplinary teams to achieve optimal outcomes.
Skilled in using electronic medical records (EMRs) to document, maintain, and manage accurate clinical and case management information.
Skilled in verbal and written communication to convey complex medical, financial, and psychosocial information clearly to patients, families, payers, and interdisciplinary teams.
Skilled in critical thinking, clinical judgment, and decision-making to assess patient needs, determine appropriate levels of care, and facilitate timely transitions.
Skilled in conflict resolution, service recovery, and de-escalation strategies to maintain positive patient and staff experiences.

Nice To Haves

Master’s degree preferred.
Certification in Case Management (e.g., CCM, ACM, or ANCC) preferred or willingness to obtain certification within two (2) years of hire.
At least two (2) years of recent experience in hospital-based case management, care coordination, discharge planning, or related field preferred.

Responsibilities

Coordinate and facilitate timely, appropriate care across the continuum to meet patients’ clinical, psychosocial, and financial needs from admission through discharge and transition of care.
Perform comprehensive assessments and reassessments of patients’ medical, emotional, and psychosocial status to identify care needs, barriers to discharge, and required resources.
Develop, implement, and update individualized care and discharge plans in collaboration with patients, families, physicians, nursing staff, and the interdisciplinary care team.
Conduct ongoing utilization review (UR) by evaluating the medical necessity, appropriateness, and efficiency of hospital admissions, continued stays, and services, using established criteria such as InterQual or MCG.
Document and submit clinical reviews accurately and timely to support continued stay authorizations, prevent denials, and maintain compliance with regulatory and payer.
Collaborate with payers and the revenue cycle team to resolve authorization issues, denials, or appeals, providing additional clinical documentation as necessary.
Monitor patient progress and resource utilization, advocating for necessary services while promoting cost-effective care and adherence to payer requirements.
Initiate and manage early discharge planning, ensuring safe transitions to home, rehabilitation, swing bed, skilled nursing, behavioral health, or community-based support services.
Serve as a liaison between the hospital, external agencies, insurers, and community resources to ensure access to needed services and continuity of care.
Participate in multidisciplinary rounds and team communication, identifying and resolving barriers to care and expediting discharge when clinically appropriate.
Maintain knowledge of relevant regulations, payer guidelines, and hospital policies, ensuring compliance with Oregon state regulations, federal CMS Conditions of Participation, and accreditation standards.
Advocate for patient-centered, culturally competent, and ethical care, while engaging in ongoing professional development, continuing education, and quality improvement initiatives to enhance outcomes.

Benefits

Health Insurance
Vision Insurance
Dental Insurance
Flexible Spending Account (FSA and Health Savings Account (HSA) Options
401K Plan with Roth Options
401K 3% employer match and a 2% base non-elective employer contribution
Eligibility for company-paid benefits such as life insurance and long-term disability, subject to applicable waiting periods
Option to elect Supplemental employee, spouse, and child life insurance
Paid Time Off (PTO)
Access to the Employee Assistance Program
Discounts: available for meals in the cafeteria and over-the-counter pharmacy items
Exercise/Fitness Facility: access to the Rehab Therapy Fitness Center for the employee and dependents