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Behavioral Health - UR Case Manager RN, Decatur

Location: Decatur, Texas
Date Posted: 07-10-2018
  • Conducts verifications and notifications on potential admissions for Behavioral Health Services and/or delegates duty as clinically appropriate.
  • Provides clinical information to insurance as requested using Interqual and Milliman criteria guidelines or other medical necessity criteria as required by insurance providers to establish appropriateness of admission and documents same in MS520 system. 
  • Works closely with the Community Assessment Coordinator(s) and After Hours staff on verifications, notifications, precertification, and ongoing clinical(s).  
  • Demonstrates skill in clinical chart assessment and documents actions and plans appropriately in Clinical Suites. 
  • Conducts chart assessments on hospital patients on a daily basis to obtain and verify psychiatric criteria. 
  • Works closely with Physicians, Clinical Therapists, Program Director and Community Assessment Coordinator as a member of the total healthcare team to provide maximum assessment of continued stay criteria, discharge needs, and assessment of quality customer service related to hospital care and discharge. 
  • Participates in treatment team meeting and nurse report conferences possessing ability to communicate effectively with staff/treatment team /physician on appropriate level of care and insurance recommendations. 
  • Attends daily treatment team  meeting with Clinical and Administrative staff to discuss patient status. 
  • Assists with Discharge Planning from the hospital setting by communicating with physician and providing information regarding Interqual Criteria and appropriate level of care.
  • Meets with patient when appropriate to obtain and verifying information, notify about insurance coverage, obtain information for medication authorizations, and facilitate appropriate level of care and/ or discharge planning. 
  • Requires knowledge on psychiatric disorders, symptoms, and standards of care.  
  • Exemplifies sound clinical judgment, experience and expertise in area of psychiatric clinical management. 
  • Must possess ability and desire to work with individual of all races, ages, lifestyles, disabilities and cultures.  
  • Works independently and efficiently with skills in problem solving.  
  • Must have excellent oral and written communication skills. 
  • Requires basic knowledge and operational skills of computer and office equipments.   
  • Maintains positive working relationships with staff and other departments to provide optimal quality outcomes within the framework of professional nursing practice. 
  • These responsibilities are met according to hospital policy, hospital mission statement and the philosophy of the Department of Nursing.

  • Reports operationally and administratively to the Program Director of Behavioral Services
  • Reports to Chief Nursing Officer for nursing practices
  • 1.  Current RN licensure by the State Board of Nurse Examiners.  
  • 2.  Must have current CPR license.
  • 3. Meets the requirement for Pre-Admission Screening Professional (PASP) as defined by the state of Texas.
New Hires will have 60 days to acquire the required Basic Life Support (CPR, ACLS, PALS, BLS, and/or any other life support certifications required for the job).
  • There is occasional risk of exposure to mucus membranes or skin contact with bloody, body fluids, or tissues or potential spills or splashed during the performance of the job. 
  • Universal precautions must be observed and protective devices worn by employee when performing tasks that is likely to cause exposure
Employment standards include current requirements as determined by Federal, State, and Wise Health System policy.
  • Non-exempt hourly
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