Job Description

Location: St. Luke's Behavioral Health Center
Posted Date: 5/16/2024
Job Type: Full Time
Department: 4001.40600 CARE MGT

About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.

Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.

For more information, visit steward.org

Position Function:

-Validates the medical necessity of admission and ongoing services of patients at St. Luke’s Behavioral Health Center and verifies or obtains authorization from third party payors.

-Utilizes InterQual criteria for admission and continued stay reviews.

-Continuously collects data about the behavioral healthcare status of the patient in a systematic way to determine the need and type of care and treatment to be provided, and the need for further assessment.

-Identifies various levels of treatment available for the patient and works closely with the multidisciplinary team to coordinate/evaluate continued care and services and also advocate for appropriate discharge planning (including next level of care). Obtains authorization for next level of treatment when appropriate.

-Identifies St. Luke’s Behavioral Health Programs, individual providers and community resources, and documents options in medical record.

-She/he is accountable to problem solve for the care of the patient and to initiate immediate, effective action to maintain patient safety.

-Responsible to meet Medicare/Medicaid regulatory requirements related to the provision of services for inpatient and outpatient mental health treatment.

-Interfaces with external health-care professionals and providers to coordinate patient movement to a less restrictive level of care and ensures continuity of care.

-Completes utilization documentation as required (CON/RON/Payor forms and CM notes).

-Ensures reimbursement from third party payors through the appeal process (completes appeal

letters).

-Completes CMS form 100% of the time and places on the Medical Record ensuring that physician

signs, dates and includes time the CMS form is signed.

Job Relationships:

-Maintains a collaborative relationship with all payors, hospital, medical and leadership staff.

-Demonstrates an ability to be flexible, organized and function under stressful/emergency situations.

-Communicates with physicians/director/charge nurse/co-workers, as appropriate about changes in patient’s clinical condition including results of assessment and treatment modalities.

-Serves as a resource to all patients and health care team.

Authority:

-To problem solve patient care issues and initiate resolution through contact with chain of command.

Responsibilities/Essential Functions:

-Follows all safety and infection prevention guidelines.

-Implements hospital policies established by St. Luke’s Behavioral Health Center.

-Keeps director and management apprised of administrative and clinical issues.

-Demonstrates leadership skills oriented towards quality care delivered efficiently with appropriate utilization contributing to the overall smooth operation of the department and organization.

-Participates in performance improvement activities.

-Demonstrates an ability to be flexible, organized and function under stressful/emergency situations.

-Performs related duties as directed by the Director of Case Management.

Reporting Requirements:

-Reports to the Director of Case Management.

-Reports to work on time as scheduled and completes work in designated time.

-Meets dress code standards of Steward Health Care.

-Reports serious incidents and/or severe breaches in the quality of care to the Director of Case Mangement, hospital President, risk manager, or quality director.

-Informs the Director of any significant event that affects the organization.

Accountability:

-Is accountable for maintaining the confidentiality and security of all hospital-related, medical-staff related, and patient-related data and information.

-Is accountable for following St. Luke’s Behavioral Health Center policies and procedures.

-Is accountable for managing, monitoring and implementing quality patient care.

Qualifications:

Minimum Education/Experience:

- Master’s degree preferred from an accredited University in behavioral health field with 3 years experience. Bachelor’s Degree Required with 2 years behavioral health experience.

-Certified Case Manager (CCM)

Minimum skills/abilities:

· Able to communicate verbally and in writing in the English language.

· Basic computer knowledge

Certification:

· Biannual CPR certification

· Annual Management of Aggressive Behavior Certification

· Annual American Case Management Association COMPASS Training

· Annual Education requirements through Steward University

· Current Level 1 Fingerprint Card

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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