Responsible for the coordination and implementation of case management activities on Behavioral Health Services. Works with all members of the healthcare team to assure a collaborative approach is maintained in care and treatment of the patient. Reviews care and treatment for appropriateness against screening and reimbursement criteria. Responsible for authorization of appropriate services for admission, continued stay and through discharge. Plans and coordinates home care services and needs.
DUTIES AND RESPONSIBILITIES:
Performs UR assessments on patients admitted for inpatient and outpatient behavioral health services.
Possesses advanced knowledge of Medicare and Medicaid and other third-party reimbursement methodology, procedures, coding and requirements.
Maintains and keeps current reimbursement documentation in collaboration with the business office.
Maintains current knowledge of third-party reimbursement and guidelines, maintains current knowledge of all payers.
Consults with physicians and therapists for clarification of clinical data when necessary to ensure maximum charge capture, billing and collections.
Maintains current knowledge of reimbursement practices, medical record practices and the standards and regulations of CMS, JCAHO and other regulatory agencies.
Orders and arranges for home care equipment, healthcare needs.
Works with third party payers to validate need for patient care and home care environment needs.
Completes documentation necessary for third party reimbursement.
Demonstrates an ability to be flexible, organized and function under stressful situations.
Maintains a good working relationship both within the department and with other departments.
Consults other departments, as appropriate, to collaborate in patient care.
Functions as a patient/family advocate.
Documentation meets current standards and policies.
Demonstrates the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.
Demonstrates the ability to deal with a variety of people, deal with stressful situations, and handle conflict.
Demonstrates ability to perform job specific competencies (refer to skills checklist).
Adheres to dress code.
Completes annual educational requirements.
Maintains regulatory requirements.
Wears identification while on duty.
Maintains confidentiality at all times.
Attends department staff meetings as required within the department.
Reports to work on time and as scheduled; completes work in designated time.
Represents the organization in a positive and professional manner.
Actively participates in performance improvement and continuous quality improvement (CQI) activities.
Coordinates efforts in meeting regulatory compliance, federal, state and local regulations and standards
Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.
Complies with Benefis Health System Organization Policies and Procedures.
Complies with Health and Safety Standards and Guidelines.
Current State Registered Nurse Licensure. Or master's degree in counseling related field.
Prefer one or more years case management experience or experience working on an inpatient behavioral healthcare unit.
As a not-for-profit community health system, Benefis is driven to provide the highest level of care. We serve nearly 230,000 residents across a 15-county region that is bigger than Connecticut, Massachusetts, New Hampshire and Vermont combined. Benefis is the largest non-governmental employer in the Great Falls area, with more than 3,000 employees.Benefis has 530 licensed beds (that includes 146 beds in long-term care, 71 in assisted living and 20 beds at Peace Hospice of Montana) and partners with over 250 area physicians.Our hospital has been recognized for its exceptional work in quality care by providing a wide range of programs and services to help you live the best life possible. We’re here to help you “Live well.”Benefis Health System came about when two Christian-based hospitals became one. Our founders believed in providing good care to all in need, and trusted that this would be accomplished. The Benefis name was derived using Latin root words: "Bene-" meaning good, and "fis-" for faith and trust. It’s these same root words that make up such terms as ‘beneficial’ and ‘confidence’.Benefis has been a trusted provider of care for more than 125 years. And our name speaks to o...ur commitment: good care one can put faith in.Benefis is consistently ranked among America’s top hospitals by the nation’s leading healthcare ratings organizations for a range of services, including cancer care, joint replacement, stroke treatment, wound care and home health.To learn more about our services, continue looking through our website at WWW.BENEFIS.ORG or call 406.455.5000.