Care Manager Utilization Review

Hampton, Virginia For over 100 years, we have made it our mission to care for others as we would care for those we love. Riverside Behavioral Health Center in Hampton, Virginia is currently seeking a full-time day shift Care Manager. Hours: Full-time, days, Tuesday-Saturday Overview This position must demonstrate by education and/or training a background in the assessment and treatment of adolescents and adults seeking psychiatric and/or chemical dependency treatment. The position performs Utilization Review activities to include pre-authorizations, review of admissions and continued stay reviews for medical necessity, using approved criteria, completes all medical record documentation and other written assignments (CM Screening Form) outlined in the department/hospital policy. The Care Manager serves as the treatment team coordinator and court services liaison, calls treatment team, completes multidisciplinary treatment team documents according to policy, and provides treatment team with medical necessity information. The Care Manager is the discharge planner and ensures patients/residents are provided age appropriate aftercare plans. Continuity of care is ensured by providing copies of the aftercare plan to providers. In addition, the Care Manager identifies opportunities to improve quality and decrease cost in all areas of responsibility through an interdisciplinary approach and maintains positive interpersonal relations through professional interactions and communications. What you will do Takes on additional work and/or assists others in the completion of their work during periods of high census and heavy workloads. Demonstrates the ability to effectively collaborate with payer sources and to conduct certification reviews. Provides follow up actions as needed. Provides quality and clinically sound care coordination and discharge planning reflective of the patient’s status and age, treatment needs, as described in the policy and procedure guide. Actively coordinates and documents patient care with referral and payor sources. Demonstrates excellent customer service in person and via telephone, projecting a professional image at all times. Serves as the initial point of contact for patients, families, and referral and assures they are active participants in the treatment planning process. Identifies process improvement opportunities related to efficiency, appropriateness, productivity and/or coordination of activities/services with other departments and personnel. Uses non-patient care time in productive ways that benefit patients, residents, department, and facility. Collaborates as an active member of the interdisciplinary treatment team. Communicates patient, resident, family needs to physicians accurately and completely. Qualifications Licensed RN or Masters degree (MSW, MS, MA, Med) in Social Work, Counseling, Psychology, or related field. (Required) CPR/BLS Certification - American Heart Association/American Red Cross/American Safety and Health Institute (AHA/ARC) (Required within 30 days of hire) #ZR As a Riverside team member, our benefits have you covered: Health & Wellness: Medical Plan Options Vision and Dental plans (including orthodontic care) Wellness & fitness center discounts Onsite pharmacy and delivery options Riverside services discount flexible spending and savings accounts healthy lifestyle incentives Peace of Mind: Group Term Life and AD&D Insurance Short Term Disability Whole Life Insurance Critical Illness Insurance Accident Insurance Legal Insurance Pet Insurance Financial Support: Student Loan Repayment Program CEUs (MedBridge Education) 403(b) Savings Plan (Immediate Matching) Specialty Certification Financial Assistance Company Wide Bonus Program Employee Help Fund Work-Life Balance: Paid Time Off (full- and part-time team members) extended illness bank care.com membership Employee Assistance Program Adoption Assistance area retail discounts community involvement opportunities