RN Utilization Review/Case Management - Behavioral Health

Job Description

Description

PeaceHealth is seeking a RN Utilization Review/Case Management - Behavioral Health for a Per Diem/Relief, 0.00 FTE, Day position. The general salary range for this job opening at PeaceHealth is $41.20 – $61.80. The actual hiring rate is dependent upon several factors, including but not limited to, the job/position responsibilities, location, terms of the applicable collective bargaining agreement, education, training, work experience, seniority, work performance, etc.

Enjoy metropolitan amenities with a small-town feel in Eugene-Springfield! Located between the Cascade mountains and the Pacific Ocean the area offers an adventure-driven community with spectacular waterfalls, stunning beaches, world-class ski slopes, crystalline rivers and miles of scenic bike paths in your backyard. Don't forget your hiking boots!

Responsible for promoting effective utilization and monitoring of healthcare resources, along with medical case management of patients with chronic unstable conditions and patients who have been recently hospitalized. This position will assume a leadership role with the interdisciplinary team to achieve optimal clinical, financial, and satisfaction outcomes.

Details of the position:

• Acts as intermediary between the hospital and third party payors to ensure patients receive appropriate medically necessary inpatient psychiatric and medical services, so that the organization receives appropriate and optimal reimbursement.
• Screens admission referrals in conjunction with the psychiatrist and through the filter of Behavioral Health Inpatient Unit’s admission criteria. Understands and adheres to Medicaid standards. Gathers all needed referral information to inform decision. Monitors accepted admissions from off hours and educates regarding admission criteria as needed.
• Ensures the best use of limited inpatient resources by confirming that accepted patients meet medical necessity criteria and will benefit from hospitalization.
• Communicates proactively and adeptly with members of the interdisciplinary team to ensure hospital and community resources are appropriately and effectively utilized on behalf of patients and their families.
• Collaborates closely with other departments such as Patient Financial Services, Health Records and Contracting to ensure efficient work process in obtaining authorizations, timely payment and proper billing in patient accounts.
• Guides discussion in treatment teams to improve quality, decrease cost and improve patient satisfaction. Communicates variance days to treatment team and to manager.
• Monitors all disciplines’ documentation to ensure it supports need for acute and ongoing psychiatric inpatient care in order to reduce denials. Ensures all disciplines document to Medicaid/ Medicare standards. Provides education and feedback to disciplines and/or individuals to standardize documentation.
• Works closely with Patient Financial Services to assist in decreasing denials.
• Maintains issue tracker related to third party denials and interfaces with management as needed to initiate investigation of denials.
• Maintains issue tracker related to CDMP issues and communicates medical co-morbidities to treatment team. Identifies and evaluates medical co-morbidities for billing purposes.
• Communicates adeptly and within designated time frames with third party payors in order to obtain authorizations and resolve payment issues on behalf of patients and families and the organization.
• Oversees and supports staff with wound care and patient education.
• Oversees and supports Electroconvulsive Therapy (ECT) process.
• Attends unit leadership meetings. Collaborates regarding unit issues and quality assurance. Provides staff education as appropriate.
• Performs medical case management, including patient education regarding chronic and complex medical conditions; monitors relevant lab values, obtains medical history, arranges medical follow-up appointment post-surgical procedures, orders medical home health, CPAP, RT etc.
• Provides professional nursing presence and oversight based on unit needs.

What you bring:

• Graduate of an accredited State Board of Nursing approved nursing program required
• Bachelor’s degree required or completed within one year of hire.
• Minimum of 3-5 years psychiatric clinical work required
• Working knowledge of psychiatric diagnostics required
• Third party reimbursement knowledge desirable
• Current RN licensure in state of practice required
• Willingness to work toward CPUR certification preferred

PeaceHealth is committed to the overall wellbeing of our caregivers. The benefits included in positions less than 0.5 FTE are 403b retirement plan for caregiver contributions; wellness benefits, discount program, and expanded EAP and mental health program.

For a full description or questions about the position, contact Melissa, [email protected] 

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

PeaceHealth requires a completed Primary Vaccine Series (e.g., 2 dose monovalent Pfizer, Moderna or Novavax series or 1 dose J&J vaccine series) or be Up to Date (receiving the most recent Pfizer/Moderna bivalent vaccine/booster) for COVID-19 vaccination prior to their start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due to medical/religious reasons. For caregivers that will be working in Oregon there is a personal vaccine exemption form that may be requested.