Overview

PURPOSE STATEMENT:

Clinical professional responsible for facilitating admissions, clinical intake assessments and utilization review processes to assure continuity for the most appropriate level of care for patients and their benefit/resources utilization.

Responsibilities

ESSENTIAL FUNCTIONS:

Respond to inquiries about the facility within facility policy timeframes.
Ability to develop therapeutic relationships with patients and families.
Perform benefit eligibility to ensure patient benefits are active at the time of admission. Communicate benefit eligibility to the business office and the patient or significant other.
Collaborate with other facility medical and psychiatric personnel to ensure appropriate recommendations regarding pending referrals.
Coordinate admission and transfer from referral sources and between levels of care within the facility.

Maintain knowledge of milieu management.
Communicate projected admissions to designated internal representatives promptly.
Ensure all clinical information from referral sources or patient (including medical comorbidity information) is received, when possible, prior to patient admission.
Schedule (when applicable) and complete pre-admission assessments, consult with the admitting physician, and communicate disposition recommendations to patient or their family.
Possess skill in preparing and maintaining appropriate medical record documentation that will result in authorization at the level of care being requested of the payor.

Complete initial pre-authorization for treatment and admission prior to admission, when possible, and within payor timeframe guidelines.
Admit patient in the registration and accounting system. Complete all admission and consent forms with the patient.
Demonstrate a positive, empathetic and professional attitude towards customers always. When patient needs are not met, acknowledge and work to resolve complaints. Recognize that patient safety is a top priority.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Bachelor’s degree in a social services field required (if state allows).
Master's degree in a social services field (psychology, counseling, social work, sociology, health administration, nursing) or RN preferred.
Three or more years’ experience in mental/behavioral health working with individuals in a clinical or observational capacity preferred.

Experience in the managed care pre-certification process, level of care assessments and utilization preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

Current licensure, as required for the area of clinical specialty, i.e., current RN license, CAC or other clinical counseling or therapy license, as designated by the state in which the facility operates.
CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).
First aid may be required based on state or facility.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

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