Coordinates systems and services with an organized, transdisciplinary team approach which delivers quality, cost-efficient care to patients through the continuum of health care services. Appropriateness of admission and continued stay reviews are conducted concurrently or retrospectively. Collaborates with the patient, family and other members of the health care delivery team to facilitate appropriate movement through the care continuum as demonstrated through quality outcomes. Works effectively with internal and external customers and proactively improves case management processes. Provides direct input to St. Anthony Hospital annual Utilization Management/Case Management/Performance Improvement Plans and is accountable for the successful completion of the action plan developed.
- Assess data to determine medical necessity and appropriateness of level of care/admission based on approved criteria. Complete insurance verification and authorizations for specific pt population from preadmission through discharge.
- Manage patient's benefits by checking insurance eligibility to optimize payment of services rendered for alternative cost-effective levels of care. Notify physician, business office, and patient/family of insurance denials.
- Attend weekly treatment team meetings with physicians, therapists, and nursing staff to discuss treatment options, benefits, insurance authorizations, and discharge planning.
- Collect, record, and maintain clinical information gathered from concurrent or retrospective review and assess for medical necessity criteria. Utilize EPIC for documentation purposes.
- Display self-motivation through designing, planning, and initiating work processes and activities with minimal supervision. Attends and actively participates in departmental, hospital and medical staff meetings as assigned.
- Familiarize self with all behavioral medicine units and is cross-trained to provide services in case management for each unit including in patient and day treatment.
- Perform other related duties as directed that correspond to the overall function of this position.
- Bachelor's degree in mental health or related field.
- Skill and proficiency in applying highly technical principles, concepts and techniques that are central to the mental health care profession.
- Knowledge of computer software and hardware application ad basic knowledge of statistics.
- Master's degree in Mental Health.
- Licensure or registration by appropriate mental health certifying body.
- Utilization Review/Utilization Management or Case Management experience.
St. Anthony Hospital –
St. Anthony Hospital is a 601-bed regional referral facility specializing in cardiology, oncology, surgery and behavioral medicine. The hospital, established in 1898, is located in Midtown Oklahoma City and serves the needs of Central Oklahoma, as well as many counties throughout Oklahoma, through its large rural affiliate network of hospitals. Four St. Anthony Healthplex campuses provide convenient emergency and outpatient service access to the outlying communities of the metropolitan area. St. Anthony added urgent care services in May 2015 at St. Anthony North. St. Anthony has received numerous awards including the Oklahoma Quality Award for Excellence, Certified Healthy Business, Premier QUEST® Award for High-value Healthcare Citation of Merit, among others. Healthsights ranks St. Anthony at performance levels for quality and patient satisfaction higher than local competitors and many national health care organizations.