HCA, Hospital Corporation of America Case Mgr Behavioral PRN in Madison, Tennessee
TriStar Skyline Madison Campus
Behavioral Case Manager
TriStar Skyline Madison Campus is the region’s most comprehensive provider of inpatient and outpatient behavioral health and chemical dependency services. Care is provided in a variety of settings in order to best accommodate the patient, including inpatient care, partial hospitalization and intensive outpatient care. From adolescents to adults and the military, services are designed to meet the specific needs of patients. A therapeutic treatment mall program is also available, which enables patients to participate in multiple classes to meet their specific behavioral health treatment objectives.
All programs are based on the belief that mental illness is treatable in a supportive, therapeutic environment. Our team of psychiatrists, counselors, social workers, case managers, dieticians, certified activity therapists and a dedicated patient advocate works together to develop an individualized treatment plan for each patient.
We also offer unique programs to help teenagers, adults and active/retired military members. Our substance abuse treatment program helps adults who are battling drug and alcohol addiction.
These programs incorporate the new treatment mall concept, which enables patients to select from numerous skills based classes that meet their specific treatment objectives. The classes enable patients to participate in treatment that takes place apart from their units to more closely imitate life in the community. Patients participate in activities like physical exercise and games while learning organization, personal life, coping, and problem solving and stress management skills.
Skyline Madison Campus is currently looking for a Behavioral Case Manager
- Actively participates in departmental PI, as assigned by Quality Coordinator.
- Completes high quality work in accordance with outlined standards and procedures within defined time frames.
- Sets priorities and demonstrates effective organizational skills by optimizing use of time, meeting deadlines and completing assigned tasks in a cost effective manner.
- Functions as a liaison with Psychiatrists, Nursing Staff, Unit Therapists, and Managed Care Organizations.
- Maintains appropriate clinical reports with multidisciplinary team members, as well as PAS.
- Demonstrates knowledge and competence with the electronic medical record.
- Participates in treatment teams with Medical Directors, staff psychiatrists, and other clinicians as appropriate.
- Provides back up to other team members as appropriate and/or assigned.
- Discusses issues related to staff, group, clients, and other customers with the Clinical Services Manager or department Director, as appropriate.
- Reviews concurrently all payer type inpatient medical records against various medical necessity criteria.
- Assures that documentation, certifications, and demographic data for all assigned cases are accurate.
- Performs reviews according to time frames indicated by policy and/or the Managed Care Organization.
- Alerts Director and/or Clinical Services Manager and appropriate clinical staff of potential problems affecting insurance reimbursement.
Assures appropriate level of care and length of treatment for all assigned cases.
Demonstrates ability to make appropriate referrals to next level of care providers with the clear understanding that continuing care planning begins at the time of admission.
Demonstrates working knowledge of area referral resources
Knowledge of CMS requirements and 2 midnight rule and implementation of such
Demonstrates the ability to complete all post discharge follow-up as outlined by HBIPS and/or the Managed Care Organization.
Manages cases through to resolution.
Demonstrates the ability to complete retroactive appeals to include writing effective appeal letters
- Demonstrates ability to integrate age specific factors into the plan of care and involves the patient and family in the care plan process as appropriate to age. (Serve Adolescent, Adult and Geriatric populations.)
- Consistently protects patient confidentiality as outlined in state and federal statutes.
Willingly performs other related duties as assigned or requested in a flexible and positive manner.
- Familiarity with required DSM -5 diagnoses, inpatient psychiatric treatment protocols, brief therapy, and chemical dependency intervention knowledge and skills.
- Possesses knowledge of medical model, psychotropic medications, familiarity with full range of treatment options and mental health service delivery systems.
- Demonstrates interpersonal skills necessary to advocate for patients in regards to managed care organizations.
- Conducts utilization review and case management for managed care cases on assigned psychiatric units.
- Requires current Tennessee RN license or Bachelors Degree in Social Work, Psychology, Counseling, or related mental health field.
Requires two to five years experience working in a behavioral health setting, preferably psychiatric inpatient experience; or five years post graduate supervised broad clinical experience
Successful completion of CPI training (Parts 1 & 2) within 1 month of hire and annually thereafter
BLS through the American Heart Association required
Title: Case Mgr Behavioral PRN
Location: Tennessee-Madison-Skyline Madison Campus
Requisition ID: 25070-55914