Case Mgmt/UR Specialist-PBH

Summary

Coordinates, verifies, negotiates alternatives and manages the care of Parkview Behavioral Health (PBH) patients to facilitate the achievement of quality and cost effective patient outcomes. Works collaboratively with interdisciplinary staff, both internal and external to the organization, to overcome barriers to patient progress and desired outcomes. Continuously evaluates the quality, care, treatment and outcomes of their assigned patient group. Participates in quality improvement and evaluation processes related to the management of care. Provides mentoring with staff in understanding and working in the managed care environment developing capabilities of all team members and transitioning the patient through the continuum of care in a seamless manner. Responsible for creating and installing systems to obtain precertification and recertification for payment and utilization review. Attends treatment planning to advise regarding reimbursement issues.

Education

Requires a Diploma in Nursing or an Associate of Science in Nursing (ASN); Bachelor of Science in Nursing (BSN) preferred.

Licensure/Certification

Current Indiana RN license. CPI required upon hire or within 3 months of employment. CPR required upon hire or within 3 months of employment.

Experience

Two years of psychiatric nursing. Case management, quality assurance experience preferred.

Other Qualifications

Application of and use of review criteria related to clinical evaluation of appropriate levels of psychiatric care. Must be available to work flexible hours and days of the week possibly including weekends and evenings, must have good verbal and written communication skills. Must have excellent people skills and the ability to problem solve efficiently and effectively.