AMVETS Jobs

Utilization Manager

UnityPlace-Methodist Hospital-Community Behavioral Health

Full-Time, 40 hours/week, Benefitted

1st Shift, Monday-Friday

To provide utilization management services to the inpatient unit facilitating the delivery of appropriate, cost-effective, and clinically effective services across the continuum of care.

About UnityPoint Health - UnityPlace:

UnityPoint Health - UnityPlace is proud to offer the most comprehensive addiction and mental health services in the Peoria, Illinois region to you and your family. UnityPlace was formed by the joining of UnityPoint Health®, Human Service Center and Tazwood Center for Wellness in April of 2019. UnityPlace is a new non-profit organization dedicated to meeting the growing behavioral health care needs of the community. Our compassionate and committed treatment team is comprised of many experts from psychiatry and addiction medicine.

Our goal is to deliver comprehensive behavioral healthcare to optimize the patient's well-being. It is our privilege to partner with our patients on their journey of healing.

As a member of the UnityPlace Team, our team members are eligible for a benefits package including:

• Medical

• Dental

• Vision

• Retirement

• Paid Time Off

Additional benefits are available, apply today to discuss our full benefits package!

Why UnityPoint Health?

• Culture – At UnityPoint Health, you Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.

• Benefits – Our competitive Total Rewards program offers benefits options like 401K match, paid time off and education assistance that align with your needs and priorities, no matter what life stage you’re in.

• Diversity, Equity and Inclusion Commitment – We’re committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.

• Development – We believe equipping you with support and development opportunities is an essential part of delivering a remarkable employment experience.

• Community Involvement – Be an essential part of our core purpose—to improve the health of the people and communities we serve.

Visit us at UnityPoint.org/careers to hear more from our team members about why UnityPoint Health is a great place to work. https://dayinthelife.unitypoint.org.

Essential Functions/Responsibilities:

Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

% of Time

(annually)

Collaborates with the interdisciplinary team to facilitate placement of patients in the most appropriate level of care and ensure insurance requirements are met from initial contact through admission.

· Reviews all admissions immediately following the admission and no later than the next business day after the admission to determine the appropriateness of the admission.

· Discusses with the psychiatrist, any concerns regarding admissions related to the level of care the patient is receiving.

· Applies admission, continued stay/transfer, and discharge criteria to each patient.

· Reviews all patients' records a minimum of every two days to determine appropriateness of the level of care.

· Monitors patient’s payor requirements.

· Works with the Patient Financial Services Department to ensure patients meet financial eligibility for treatment services.

· Participates in interdisciplinary treatment conferences (clinical staffing) within 72 hours of admission and at least twice a week to review patient's progress, in order to report to payors and plan for discharge.

· Maintains a working knowledge of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), the current Mental Health and Developmental Disabilities Code and the current Illinois Department of Human Services' Mental Health and Developmental Disabilities Confidentiality Act.

· Maintains a working knowledge of psychotropic medication.

· Maintains current knowledge of standard evidence-based treatments for major mental/emotional/behavioral diagnoses common to children, adolescents, adults, and senior adults.

· Completes and submits documentation for medication prior authorizations.

25%

Works in conjunction with the interdisciplinary team to coordinate the development and implementation of the treatment and discharge plan for patient; and occasionally works in collaboration with the Behavioral Health Service Line management team to fulfill the visions of the service line and of UnityPoint Health.

· Maintains communication to ensure timely and comprehensive transmission of information throughout the continuum of care.

· Coordinates the discharge planning process with the psychiatrist, primary nursing staff, mental health clinician, and discharge planner as soon after admission as is clinically appropriate.

· Assists in referring patients in need of special placement such as nursing home, residential and supervised housing to the mental health clinician and assists in the process as needed.

· Works with payors to maximize benefits in establishing outpatient services, case management, transportation, and other essential services

· During emergencies and low patient census, functions as direct care staff when requested.

· During times of high census, collaborates with Nurse Manager and /or Lead Nurse to provide direct services to patients.

· Utilizes CPI methods to assist with aggressive/violent patients when it is necessary to protect himself/herself or others from harm.

25%

Assists in quality improvement processes.

· Collects data on care factors (including outcome measurements), assists in the analysis, generates regular reports as requested.

· Assists in completing chart reviews in a timely manner, as assigned

· Participates in the design and revisions of documentation forms and other quality improvement processes to ensure attainment of outcomes in a cost-effective manner.

· Assists the ordering physician in determining the necessity of service, impact of services on problems leading to admission, alternative/more cost-effective services, or postponing service until after discharge-collects data on physician patterns as requested.

· Assists in identifying and decreasing unnecessary ancillary services.

· Facilitates expedient physician and other responses to third party payors or reviewers' quality issues.

· Participates on unit council and contributes to quality improvement reviews and feedback.

20%

Identifies and utilizes opportunities to assure that the appropriate maximum allowable reimbursement is obtained for the care rendered to the patient.

· Communicates with payors to ensure authorization of reimbursement of care provided

· Educates psychiatrists, nurses, and other providers of care in effective documentation to improve patient outcomes, improve utilization of resources, and ensure reimbursement.

· Serves as a liaison between inpatient and outpatient services if and communicates with the patients' funding source and patients and families regarding the treatment plan.

· Maintains and updates knowledge of community resources.

· Knowledgeable in Medicare/Medicaid and third-party regulations

20%

Basic UPH Performance Criteria

· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

· Demonstrates ability to meet business needs of department with regular, reliable attendance.

· Employee maintains current licenses and/or certifications required for the position.

· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

· Completes all annual education and competency requirements within the calendar year.

· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

10%

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

Bachelor’s degree in psychology, social work or related field.

Master’s degree in social work, psychology or related field.

Experience:

Minimum of 3 years of experience in behavioral health.

Health care experience preferred.

Insurance utilization experience preferred.

License(s)/Certification(s):

Must become CPI certified and maintain certification throughout employment (renewal every year).

Must maintain current Basic Life Support (BLS) certification.

Knowledge/Skills/Abilities:

Writes, reads, comprehends, and speaks fluent English.

Basic computer knowledge using word processing, spreadsheet, email, and web browser.

Multicultural sensitivity

Critical thinking skills using independent judgment in making decisions.

Advanced reading, writing and oral skills

Ability to utilize PC including, basic elements of Windows environment, keyboarding, work with mouse, and perform basic computer tasks with instruction.

Other:

Use of usual and customary equipment used to perform essential functions of the position.

Work may occasionally require travel to other UPH facilities/hospitals.

Required to drive your own vehicle for business purposes.

Shared office space for all or a portion of the workday

Requisition ID: 2023-129272

Street: 221 NE Glen Oak Ave

Name: 5020 UnityPoint Health Methodist Medical Center

Name: Community Behavioral Hth- MMCI

FLSA Status: Non-Exempt

Scheduled Hours/Shift: Day shift Mon-Fri

External Company URL: http://www.unitypoint.org