Utilization Manager-Adolescent Psych IP YMC

• Reviews all admissions immediately following the admission and no later than the next business day after the admission to determine the appropriateness of the admission.
• Discusses with the psychiatrist, any concerns regarding admissions related to the level of care the patient is receiving.
• Applies admission, continued stay/transfer, and discharge criteria to each patient.
• Reviews all patients' records a minimum of every two days to determine appropriateness of the level of care.
• Monitors patient's payor requirements.
• Works with the Patient Financial Services Department to ensure patients meet financial eligibility for treatment services.
• Participates in interdisciplinary treatment conferences (clinical staffing) within 72 hours of admission and at least twice a week to review patient's progress, in order to report to payors and plan for discharge.
• Maintains a working knowledge of the Diagnostic and Statistical Manual of Mental Disorder (DSM-V), the current Mental Health and Developmental Disabilities Code and the current Illinois Department of Human Services' Mental Health and Developmental Disabilities Confidentiality Act.
• Maintains a working knowledge of psychotropic medication.
• Maintains current knowledge of standard evidence-based treatments for major mental/emotional/behavioral diagnoses common to children, adolescents, adults, and senior adults.
• Completes and submits documentation for medication prior authorizations

• Maintains communication to ensure timely and comprehensive transmission of information throughout the continuum of care.
• Coordinates the discharge planning process with the psychiatrist, primary nursing staff, mental health clinician, and discharge planner as soon after admission as is clinically appropriate.
• Assists in referring patients in need of special placement such as nursing home, residential and supervised housing to the mental health clinician and assists in the process as needed.
• Works with payors to maximize benefits in establishing outpatient services, case management, transportation, and other essential services
• During emergencies and low patient census, functions as direct care staff when requested.
• During times of high census, collaborates with Nurse Manager and /or Lead Nurse to provide direct services to patients.
• Utilizes CPI methods to assist with aggressive/violent patients when it is necessary to protect himself/herself or others from harm

• Collects data on care factors (including outcome measurements), assists in the analysis, generates regular reports as requested.
• Assists in completing chart reviews in a timely manner, as assigned
• Participates in the design and revisions of documentation forms and other quality improvement processes to ensure attainment of outcomes in a cost-effective manner.
• Assists the ordering physician in determining the necessity of service, impact of services on problems leading to admission, alternative/more cost-effective services, or postponing service until after discharge-collects data on physician patterns as requested.
• Assists in identifying and decreasing unnecessary ancillary services.
• Facilitates expedient physician and other responses to third party payors or reviewers' quality issues.
• Participates on unit council and contributes to quality improvement reviews and feedback.

• Communicates with payors to ensure authorization of reimbursement of care provided
• Educates psychiatrists, nurses, and other providers of care in effective documentation to improve patient outcomes, improve utilization of resources, and ensure reimbursement.
• Serves as a liaison between inpatient and outpatient services if and communicates with the patients' funding source and patients and families regarding the treatment plan.
• Maintains and updates knowledge of community resources.
• Knowledgeable in Medicare/Medicaid and third-party regulations

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We've grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We're developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world's first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.