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Prime Healthcare

Acquires and reorganizes underperforming hospitals

Intake Case Manager - Social Work Services

Mental & Behavioral HealthPosted on Nov 11
Part-timeWoonsocket, RI, USANo salary listedIn-person

About the Job

Requirements

  • Maintain an active Rhode Island license as a Registered Nurse, Licensed Clinical Social Worker, or Licensed Independent Clinical Social Worker.
  • Have at least 5 years of psychiatric experience.
  • Have greater than 2 years of management experience; preferred.
  • Have experience in psychiatric emergency and triage; preferred.
  • Have knowledge of Milliman Criteria and InterQual Criteria; preferred.
  • Have knowledge of psychiatric medical necessity and case management regulations in discharge planning.

Responsibilities

  • Initiate triage for patients presenting to the Emergency Department in psychiatric emergency crisis.
  • Ensure the quality of emergency triage and appropriate resource management for patients requiring emergent psychiatric assessment, triage, disposition, or crisis management.
  • Assess psychiatric patients presenting to the Emergency Department or any acute care unit.
  • Ensure appropriate admission or disposition for patients presenting with potential psychiatric illness.
  • Ensure regulatory standards for psychiatric admission are met and coordinate with the attending psychiatrist to obtain appropriate admission orders.
  • Coordinate with community resources for appropriate disposition when the facility cannot meet a patient's care needs.
  • Perform utilization review related to triage and admission to the Behavioral Health Unit.
  • Advocate for patients and promote cost containment while integrating healthcare providers to support seamless care across the continuum.
  • Support quality, clinical and cost-effectiveness, and use of evidence-based quality practices.
  • Conduct comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of services, and severity of illness.
  • Provide oversight throughout patient admission and across the continuum, and support interdisciplinary team members and discharge planning.

Desired Qualifications

  • Experience in psychiatric emergency and triage.
  • Knowledge of Milliman Criteria and InterQual Criteria.

About the Company

Prime Healthcare

Acquires and reorganizes underperforming hospitals

Prime Healthcare operates a network of hospitals and outpatient centers across the United States, concentrating on turning around financially struggling facilities. It invests in infrastructure and technology, restructures operations, and negotiates payer terms (including pursuing higher out-of-network reimbursements) to improve financial performance, and it manages both for-profit hospitals and not-for-profit facilities through the Prime Healthcare Foundation. The company aims to raise clinical quality and patient safety while expanding access in hundreds of communities, though it has faced legal and regulatory scrutiny over billing practices and service-line decisions. Its goal is to stabilize and improve the financial and clinical performance of underperforming hospitals so they can continue serving their communities.

Company size
5,001-10,000
Company stage
Debt Financing
Total funding
$2.2B
Headquarters
Ontario, CA
Founded
2001

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