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Case Manager (RN)

Universal Health Services


Location:
FAYETTEVILLE, AR
Date:
04/25/2017
Job Code:
212187
Universal Health Services
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Job Details





Case Manager (RN)

Job Code:  212187
Facility: Springwoods Behavioral Health
Location: FAYETTEVILLE, AR US Midwest
Region: Midwest
Travel Involved: None
Job Type: Full Time
Job Level:  Experienced (Non-Manager)
Minimum Education Required: Professional 
Skills: Health Care -> Behavioral Health, Social Work/Case Management, Therapy
 
Category: Allied Health,Healthcare - Rehabilitation
FTE: 1.0
Position Summary:

Case Manager RN- Full-Time  

Job description may be revised in writing to add or delete duties at any time at the discretion of management.

Universal Health Services, Inc. (UHS) is one of the nation’s largest and most respected health care management companies, operating through its subsidiaries acute care hospitals, behavioral health facilities and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries now have more than 65,000 employees. The UHS business strategy is to build or purchase health care properties in rapidly growing markets and create a strong franchise based on exceptional service and effective cost control. Our success comes from a responsive management style and a service philosophy based on integrity, competence and compassion.

Interpersonal Relationships: As a representative of Springwoods Behavioral Health, all comments, attitudes, actions, and behaviors have a direct effect on the Facility’s image and perceptions of quality service. Interaction with patients, family members, physicians, referral sources, affiliating schools, visitors, etc. must be in a manner that is friendly, supportive, courteous, respectful, cooperative, and professional. This behavior should promote an atmosphere of teamwork, which is congruent with facility standards and guidelines to promote positive relations.

Position Purpose: The Case Manager, RN coordinates the design, development, implementation, and monitoring of Springwoods Behavioral Health’s case management and utilization review functions. The Case Manager will achieve the goals of clinical, financial and utilization as set forth in the UR plan by effective management and communication. The Case Manager functions as the internal resource on issues related to the appropriate utilization of resources, coordination of care across the continuum and utilization review. The Case Manager is responsible for carrying out assignments in a manner to assure success in financial management, quality and operational management objectives. The Case Manager participates in program development and unit performance improvement. The Case Manager consistently demonstrates the core values and mission statement of Springwoods Behavioral Health.

WORKING RELATIONSHIPS:

Position Reports To: Director of Case Management

Position Supervises: None

POSITION REQUIREMENTS:
• Completes daily reviews on all patients and oversees the completion of those reviews to all requesting insurance companies per contract agreement.
• Receives all denials for care involving patient stays, discusses with medical team feasibility to appeal. Manages all appeals related to denials of patient stays for all payors/insurance companies.
• Participates in quality improvement processes and assures implementation of regulatory standards.
• Ensures service is provided considering the age-specific physiological, emotional and cognitive needs of the patients served.
• Acts as a liaison between the patient/family, physician and patient care team as necessary to problem solve.
• Guides staff in the adherence to applicable standards of care/practice and/or departmental/organization expectations.
• Establishes, evaluates, and monitors case management processes, policies and procedures to ensure that appropriate Hospital resource utilization is achieved.
• Services as an internal resource and consultant to management, medical staff about case management, reimbursement, clinical resource utilization and care coordination issues.


 
Requirements

EDUCATION REQUIREMENTS:
• Minimum of 5 years of recent clinical experience preferred
• Experience in acute clinical case management and/or utilization review preferred
• Experience in related duties in the delivery of patient care, management of patient care providers or project management in a healthcare environment preferred
• Current licensure in good standing with the Arkansas Board of Nursing as a Registered Nurse (RN)
• Current BLS/AED or the ability to obtain it within 90 days from the date of hire.
• CPHM, CCM or ACM preferred

SKILLS, ABILITIES AND COMPETENCIES:
• Current knowledge of case management, care coordination and utilization review processes.
• Knowledge of or the ability to learn financial management related to UR function and reporting quality and improvement processes.
• Ability to effectively monitor, evaluate and administer the resources of each assigned area and make substantial recommendations regarding resource allocation needs for future planning.
• Ability to effectively communicate in writing and verbally
• Ability to analyze information and problem solve.
• Demonstrate evidence of strong skills in confidentiality, integrity, creativity and initiative.
• Demonstrates the ability to interact with a wide variety of individuals and handle complex and confidential sensitive situations.
• Proficient in the use of computer and multiple software programs.
• Ability to perform utilization review, assist and coordinate appeal efforts in a timely fashion.


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