UM Specialist- RN Or Master Level Social Worker

Camp Recovery Laplace , LA 70068

Posted 2 months ago

  • Provides accurate and complete clinical information to payors based on synthesized documentation in the medical record.

  • Conducts utilization review on all assigned cases and ensures authorizations are completed timely with all dates of service reviewed.

  • Completes retrospective reviews on assigned cases when updated insurance information becomes available subsequent to admission or after discharge.

  • Communicates discharges timely to payors for all assigned cases.

  • Collaborates and consults with Director of Utilization Review and Business Office Director on retrospective reviews, denials and appeals to maximize efforts to obtain authorization and overturn of adverse determinations.

  • Communicates denials to Director of Utilization Review and Business Office Director to ensure entry on the Denial Tracking Log.

  • Completes HMS entry in real time to include authorization numbers in Patient Maintenance.

  • Completes HMS entry in real time in the Utilization Review module with details of authorization/denial determinations

  • dates of service authorized/denied

  • payor contact, and

  • next steps

  • Notifies attending physician, Director of Clinical Services and unit staff of in-house denial decisions.

  • Attends unit rounds daily and treatment team meetings for assigned patients.

  • Serves as a co-facilitator for rounds by being prepared to discuss authorization status, anticipated third party review challenges and/or requirements for authorization.

  • Collaborates with the treatment team regarding quality and completeness of documentation and serves as a resource for nursing and clinical staff on documentation requirements.

  • Communicates with the responsible staff when clinical documentation is unclear, incomplete, unprofessional, not relevant to the Master Treatment Plan goals and/or fails to supports medical necessity criteria for continued stay at the current level of care.

  • Participates in routine weekly chart auditing as assigned to ensure ongoing compliance with regulatory requirements.

  • Coordinates and schedules peer reviews on assigned cases and follows through with medical staff and payors to ensure peer reviews and expedited appeals are completed timely, and documented in HMS with outcomes communicated to Director of Utilization Review, Business Office Director, CFO and CEO.

  • Discusses utilization review decisions with patients and/or family members as appropriate.

  • Coordinates with clinical staff regarding progress of discharge planning for patients whose care has been denied.

  • Effectively manages time by scheduling concurrent telephonic reviews in advance when possible to efficiently manage caseload and work hours.

  • Ensures coverage for any planned time away from the facility.

  • Communicates any incomplete work or failure to manage responsibilities timely to supervisor so responsibilities can be reassigned to prevent penalties or negative outcomes.

Working Conditions:

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may occasionally be exposed to fumes or airborne particles. The noise level in the work environment may be moderate to high. The work environment may include chemicals used for cleaning, and have dust, mist and stream generated in housekeeping tasks. Smoke-free work environment.

Must provide documentation of a current physical examination and tuberculosis test prior to beginning employment; and TB test annually thereafter.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge, Skills, and Experiences Required:

Education: Master's prepared clinician with an independent practice scope license or Registered Nurse with a minimum of two years psychiatric experience.

License: Appropriate state license required.

Experience: Must have at least one year experience in a psychiatric setting. Prior utilization review experience preferred. Demonstrated excellent verbal and written communication skills. Ability to manage caseload independently with minimal supervision.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Therapist Master Level Social Worker (Prn And Weekend)

Camp Recovery

Posted 4 weeks ago

VIEW JOBS 3/22/2019 12:00:00 AM 2019-06-20T00:00 ORGANIZATIONAL PERFORMANCE CRITERIA: Demonstrates commitment and dedication in meeting the overall corporate Values, Mission and Vision for the future. PERFORMANCE STANDARDS EVALUATION BASED ON * DISPLAYS courtesy, caring and ethical values towards work functions. * As reflected by direct supervision/ observation * DEMONSTRATES integrity and diligence in fulfilling regulatory and legal requirements as set forth in the Corporate Compliance Plan. * Patient Satisfaction Surveys * TAKES INITIATIVE in achieving personal and professional goals and growth. * New hire and/or annual training on Corporate Compliance & Ethics * Actively PARTICIPATES and PROMOTES Performance Improvement activities. * Effectively MANAGES time, and facility resources. * As reflected in compliance with time and attendance policy and responsible use of resources ESSENTIAL JOB FUNCTIONS include, but are not limited to: Weight Time Evidence of Compliance Job Function * Provides direct clinical services in accordance with accepted standards of social work/clinical practice in a timely fashion as outlined by Joint Commission, Federal and State Regulations and PI monitors. * PLANS and CONDUCTS individual, family, and/or group therapy as assigned by Clinical Director or physician's order. B. CONDUCTS, ASSESSES, and INTERPRETS completion of Psychosocial assessment within 24-48 hours of admission * PERFORMS discharge planning as assigned by the Clinical Director. 50% 50% * Skills and knowledge of group processes/therapy. 2. Skills and knowledge of individual supportive counseling/individual therapy. * Skills and knowledge of family dynamics and therapy. * Timely patient assessments * Timely and thorough MTI. * Timely Treatment Plan initiation and weekly reviews. * Timely weekly summaries. * Timely patient education documentation * PARTICIPATES as an active member of the treatment team by: * attending treatment team meetings when indicated and reporting on assigned patients and their progress toward treatment goals. * combining the reports of all disciplines into a multidisciplinary treatment integration summary, which facilitates the patient's progress towards treatment plan goals. * documenting in a timely manner in the medical record on a daily basis, the services rendered in a BIRP format. * delivering patient services in an ethical manner which promotes respect for the patient and enhances the patient's dignity and satisfaction. * DEMONSTRATES the ability to assess and interpret a patient's response to treatment in age/disability/culturally sensitive specific manner by: * demonstrating knowledge of growth and development. B.. communicating in an age/disability/culturally sensitive related manner to patients and their families. * identifying safety, psychosocial, special mobility and special equipment needs. * assessing and interpreting age/disability/cultural needs * conducting treatment and discharge planning in accordance with age/disability/cultural needs, and involving members of the patient's support system in decision making as appropriate. * passing basic competencies related to age/disability/cultural specific information in New Employee Orientation. * PERFORMS other duties as required by the Director of Clinical Services. 20% 15% 15% 20% 15% 15% * Timely CC Plan 10. Evidence of patient satisfaction with treatment program, as indicated by results of Patient Satisfaction. * Timely completion of charting entries in the medical record. A Develops, plans, and provides in-services for inter/intra-community/staff on a minimum of a bi-annual basis. * Actively participates in staff development or departmental/hospital wide committees as assigned * Collects, monitors, and maintains performance improvement procedures for services rendered in a peer review format. * Provides and maintains a safe environment for patients, families, staff, and visitors * Professionalism * Responds, assesses, and evaluates inquiry calls and executes appropriate interventions. * Rotates weekend on-call and full time weekend employee positions. H. Maintains professional licensure, complies with supervision standards, and conforms to professional ethics as delineated by the appropriate professional board. * Demonstrates teamwork through seeking, accepting, and presenting new ideas with vision, and customer sensitivity. * Performs job within productivity guidelines for the job description while being cost effective, conserving resources, timely completion and follow through on tasks according to established procedures and directions. * Demonstrates knowledge of and skills required by Policies and Procedures, including patient care, HR, confidentiality, and administrative P&P's * Adheres to safety regulations of facility as per policies and procedures and external regulatory/credentialing bodies. Identifies safety needs including ability to clinically recognize signs of abuse and neglect and intervene appropriately. * Upholds the Policies and Procedures, mission, vision and philosophy of care while maintaining an atmosphere of dignity and respect for clients served within the therapeutic milieu. * Works well with others, promotes cooperation and understanding among team members, contributes positively to setting. * Arrives at work promptly and works in a timely responsible manner. * Complies with standard precautions and infection control policies. Attends inservices and additional opportunities to improve knowledge/skills and attain required CEU's. Maintains confidentiality information. * Assesses situations and responds appropriately through prioritizing and organizing of tasks in order to achieve positive outcomes. * Work consistently meets internal standards and customer requirements. * Demonstrates competence by giving appropriate rationale for action taken. * Utilizes verbal/non-verbal communication skills to consistently achieve positive results with internal/external customers. * Respects coworkers, customers, and hospital's confidentiality. * Demonstrates commitment to customer's and hospital's goals and objectives. DESIRABLE MINIMUM QUALIFICTIONS: 0 to 1 year post-graduate experience in clinical practice. An internship within chemical dependency field is also acceptable. (Any population which is assigned will be based on a mentorship training system if no experience has been had with that population.) MINIMUM EDUCATIONAL REQUIREMENTS: Master's degree, at a minimum for a social worker, counselor, or psychologist, and at least a Bachelor's degree for BCSAC or appropriate licensure/certification . SPECIAL SKILL AND KNOWLEDGE REQUIREMENTS: Must demonstrate the knowledge and skills necessary to provide care appropriate to any age--related disability--related needs of the patients served on assignment. Must demonstrate knowledge of the principles of growth and development appropriate to the patient population served. Must be able to assess and interpret data about the patient's status in order to identify each patient's needs and provide the appropriate care, including age related care/disability/cultural sensitivity related care to adolescent, chronically mentally ill, adult, geriatric, chemically dependent, and dually diagnosed patient populations. Must demonstrate in-depth knowledge of mental illness and chemical dependency and the family dynamics which accompany them. Must have basic knowledge of chronic mental illness. Must have in-depth knowledge of clinical therapy modalities. Must have excellent communication and group/process skills as related to age specific patient needs. Must be able to demonstrate assessment, intervention, treatment and d/c planning skills. Must be able to pass the general age/disability post test. Must be versatile, flexible, and able to perform in stressful situations. Must have good time and organizational skills. Must be capable of coordinating multi-faceted workload. Must be able to work with an array of mental/physical disabled persons. Must have training in Crisis Prevention and Intervention (CPI) and CPR certification. PHYSICAL DEMANDS: Job is sedentary work and involves sitting. A certain amount of walking and standing are often necessary to carry out job duties. Lifting/carrying is limited to 10 pounds maximum and involves articles such as medical records, file folders, etc. The position also requires: Reaching Extending the hands and arms in any direction. Handling:Seizing, holding, grasping, turning, or otherwise working with the hand or hands. Fingering: Picking, pinching, or otherwise working with the fingers primarily. Feeling: Perceiving such attributes of objects and materials as size, shape, temperature, or texture by means of receptors in the skin, particularly those of the fingertips. Talking: Expressing or exchanging ideas by means of the spoken word. Hearing: Perceiving the nature of sounds by the ear. Seeing: Obtaining impressions through the eyes of the shape, size, distance, motion, or other characteristics of objects. The major visual functions are: (a) acuity -- far and near; (b) depth perception; (c) field of vision; (d) accommodation; (e) color vision. The functions are defined as follows: Acuity--far clarity of vision at 20 feet or more Acuity--near clarity of vision at 20 inches or less Depth perception three dimensional vision. The ability to judge distance and space relationships so as to see objects where and as they actually are. Field of vision the area that can be seen up and down or to the right or left while the eyes are fixed on a given point Accommodationadjustment of the lens of the eye to bring an object into sharp focus. This item is especially important when doing near-point work at varying distances. ENVIRONMENTAL CONDITIONS: Work requires spending approximately 90% or more of the time inside a building which offers protection from weather conditions but not necessarily from temperature changes. PRIMARY CUSTOMERS: Must interrelate with patients, physicians, family members, multi-disciplinary team members, and community referral sources, as well as business office, admission, and medical records staff members. POSITIONS REPORTING DIRECTLY TO THIS POSITION: None. At times, may co-supervise interns. Camp Recovery Laplace LA

UM Specialist- RN Or Master Level Social Worker

Camp Recovery