Inpatient Case Manager – Psych Utilization Review - Orlando at AdventHealth

Date Posted: 9/19/2019

Job Snapshot

Job Description

Inpatient Case Manager – Psych Utilization Review - Orlando

AdventHealth Orlando seeks to hire an Inpatient Case Manager who will embrace our mission to extend the healing ministry of Christ.

Facility Profile:

Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando, serves as the major tertiary facility for much of the Southeast, the Caribbean and South America. AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country. We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year.

Department Profile:

The Utilization Review Department at AdventHealth Center for Behavioral Health is a collaborative centered environment with targeted measures in providing excellent service delivery in a multi-disciplinary way to the patients, staff, and physicians by providing essential insurance information, education, and authorizations to encompass essential levels of care. The Utilization Review Department provides an additional measure of observation to specific federal and state guidelines quality measures, to meet enhanced quality care, and provides patients with home health referrals for continued outpatient treatment.

Work Hours/Shifts:

8a-5p; M-F

Job Summary:

The Inpatient Case Manager under the direct supervision of the Director or designee is responsible for the utilization review and case management process of patients within the Center for Behavioral Health. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Knowledge, Skills, Education, & Experience Required:

  • Excellent communication, negotiation and advocacy skills with staff, providers and health care team
  • Working knowledge of payer sources including PPO, HMO, Medicaid and Medicare
  • Working knowledge of diagnosis, assessment and treatment of psychiatric patients
  • Ability to organize and prioritize job duties in a timely and efficient manner
  • Registered Nurse, Licensed Clinical Social Worker or Licensed Mental Health Counselor
  • Bachelor’s degree in Nursing
  • Experience with acute care psychiatric nursing, leadership, utilization management, managed care and Medicaid/Medicare reimbursement

Licensure, Certification, or Registration Required:

  • Current valid State of Florida or multi state license as a Registered Nurse
  • Current active State of Florida license as a Licensed Clinical Social Worker OR Licensed Mental Health Counselor

Job Responsibilities:

Demonstrates through behavior AdventHealth’s Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization’s Performance Excellence Program.
  • Completes thorough and timely concurrent reviews daily for admissions and continued stays according to specified criteria by the Utilization/Case Management Department
  • Prepares daily census report with identification of patients’ payer status, length of stay and approved days of coverage
  • Participates in coordinating and arranging second-level review
  • Prepares and maintains ongoing statistical data to monitor utilization and case review of all patients per payer source, length of stay and denied days
  • Maintains professional relationship with clinical staff to ensure continuity of care and assist with discharge plans
  • Participates in staff education as to Utilization Process and Clinical Documentation
  • Participates in developing Quality Indicators to assess effectiveness of services
  • Promotes case management and quality improvement ideas by participation in appropriate hospital committees
  • Participates on the interdisciplinary treatment team to provide input and assist in meeting patients’ needs
  • Collaborates with Utilization Review Appeals Processor in achieving targeted outcomes
  • Performs additional duties as assigned or directed to ensure the smooth operation of the department
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Inpatient Case Manager opportunity with AdventHealth Orlando and apply online today.

Job Keywords:

Inpatient Case Manager, Psych Utilization Review, Orlando

Position Location:  Orlando
Job:  Behavioral - Mental Health
Organization:  AdventHealth Central Florida
Primary Location:  US-FL-Orlando
Schedule:  Full-time
Shift:  Day
Job Level:  Team Leader
Education Level:  Associate's Degree
Travel:  No
Job Posting:  Aug 19, 2019, 11:09:12 AM

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