Behavioral Health Utilization Management Coordinator

Overview

The Coordinator-Behavioral Health Utilization Management (BH-UMC) will review and monitor all patients admitted into psychiatry or substance abuse for appropriateness of admission according to nationally recognized criteria.

Responsibilities

The Coordinator-Behavioral Health Utilization Management (BH-UMC) will review and monitor all patients admitted into psychiatry or substance abuse for appropriateness of admission according to nationally recognized criteria. The BH-UMC will monitor discharge plan, continued stay, provide clinical information to managed care plans or other intermediaries in order to secure certification status and reimbursement for the hospital. The BHUMC will collaborate with the physician, social worker and nursing to insure that discharge plan is implemented timely, communicated to health plan and executed within appropriate length of stay allowances. The BH-UMC will work under the direction of the Case Manager assigned to Behavioral Health in order to insure that all patients are reviewed and certified. The BH-UMC will collaborate and communicate with all members of the Behavioral Healthcare team to insure that patients designated for admission have all necessary documentation to meet admission criteria for reimbursement purposes. The BH-UMC will facilitate discharges and assist the discharge planning process by identifying delays/barriers to discharge.

Knowledge of Medicare, Medicaid, Managed Care and OASIS guidelines, medical necessity criteria pertaining to psychiatry and substance abuse.

Knowledge of federal and state regulatory guidelines governing Behavioral Health

Qualifications

Minimum of three (3) years experience specifically in Behavioral Health Utilization review and case management. Managed Care or Discharge Planning experience in Behavioral Health a plus.

Bachelors/Masters