Intake Nurse and Utilization Specialist

Description

Starr Regional Medical Center is currently seeking talent to fill the position of Intake Nurse and Utilization Specialist for our GeroPsych Department. This job is permanent, full-time.

Core competencies include, but are not limited to the following:

• Ability to work independently in a fast-paced hospital environment.

• Ability to have flexible hours to meet business (hospital and patient) needs.

• Demonstrates basic understanding of legal issues associated with assessment/admission for Voluntary vs. Involuntary status, i.e. 72 Hour Hold, EMTALA and Mental Inquest Warrant processes as defined in state of practice.

• Ability to cultivate and maintain relationships with internal and external customers as well as maintains patient/family confidentiality and provides sensitive, respectful, and compassionate customer service at all times.

• Ability to work with adults and geriatric patients (18 and over) experiencing mental illness and acute psychiatric crisis.

• Capable of reviewing clinical documentation for emergency departments and identifying the symptoms that qualify of inpatient hospitalization.

• Knowledge of Diagnostic and Statistical Manual of Mental Disorder V (DSM V) or most current version.

• Understanding of mental illness and stages of development.

• Ability to present clinical findings to attending psychiatrist and charge nurse.

• Ability to coordinate the transfer of patients from other facilities.

• Documents payer interactions on assigned cases regarding authorizations with managed care review agencies, in the manner required by the Lifepoint facilities.

• Conducts review for appropriate utilization of services from admission through discharge and evaluates quality of care provided. Ensures documentation of all patient review records according to regulatory, legal and case coordination requirements and acts proactively to see that hospital resources are used appropriately.

• Performs reviews for third party payors in an accurate and timely manner.

• Communicates daily with physicians, hospital staff, family, community care providers, and patients to facilitate coordination of care. Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, and legal issues that affect patients and providers of care.

• Refers cases where patients and/or family would benefit from additional resource support to the assigned clinician. Serves as a patient advocate with payers. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.

• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, and ensure.

• Participates with physicians, nursing personnel, and other members of the management team in the planning of patient care services and the patient care plan.

• Assists in identifying opportunities for improvement, participates in data collection and analysis, contributes to problem solving and identification of actions to be taken and effectiveness of those actions. Utilizes evidence-based tools to analyze and identify trends/patterns of performance through variance reporting to improve quality and satisfaction and monitor over and under-utilization.

• Provides education and support to Clinical Staff by attending staff meetings, small groups, and one-on-one education related to resource utilization and documentation.

Knowledge/Skills/Abilities/Expectations:

• Must have good and regular attendance.

• Performs other related duties as assigned.

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.

• Background in and knowledge of hospital-based and/or third party payor utilization management and discharge planning.

• Knowledge of Medicare benefits and insurance processes and contracts.

• Knowledge of accreditation standards and compliance requirements.

• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration with physicians, payors and other external customers. Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.

• Ability to work under stress, often with conflicting priorities, and to respond quickly in emergency situations.

• Ability to work independently and effectively with all levels of the organization.

• Ability to work cooperatively and effectively as a team member.

• Ability to maintain confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.

• Approximate percent of time required to travel: Limited

Benefits Include:

• Competitive Pay

• Health Benefits (Medical, Dental, Vision) for full-time employees

• Competitive Paid Time Off / Extended Illness Bank package for full-time employees

• 401(k) plan with company match

Qualifications

Minimum EducationMaster's level degree in social or human services, MSN, BSN, Associates of Nursing, or Practical License in Nursing:• Preferred X Required

Required Licenses[Tennessee, United States] Registered Nurse

Current License in State of TN as a Registered Nurse or a License Practical Nurse: • Preferred X RequiredIndependent Practice Scope License in the state of TN, LCSW, LMFT, LPC X Preferred • Required

Minimum Work ExperienceMinimum 1 year experience in Inpatient Psychiatric Facility Utilization Management and/or intake/admissions in a psychiatric setting:X Preferred • RequiredExperience in crisis counseling and crisis evaluations:X Preferred • Required

Required SkillsCertifications:The below certifications will be required at the time of hire:X Basic Life Support (BLS)

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