Utilization Management / Clinical Care Manager

  • Company: Hospital Corporation of America
  • Location: Hopewell, Virginia
  • Posted: November 16, 2017
  • Reference ID: 02699-39768
At our facilities, we value teamwork and compassion across the spectrum of care. Take a look at what some of our team members have to say about being a part of John Randolph Medical Center. Be part of a team that puts the care and improvement of human life above all else!
https://youtu.be/CDnb9PYFxk8

John Randolph Medical Center is a community hospital serving Virginia's Hopewell, Colonial Heights, Petersburg and surrounding communities since 1915. At our hospital, you can access the advanced technology and sophisticated treatments typically found in larger medical centers, alongside high-quality, expert care and a welcoming environment.

The Utilization Manager / Care Manager will perform the following:

Gathers pertinent clinical data on assigned patients through medical record review and communication with patient's assigned clinical care manager, nursing staff and psychiatrist.*
Provides admission and ongoing clinical reviews.*
Maintains UM Documentation.*
Monitors quality aspects of care on assigned patients and initiates request for "Quality Review" according to policy.*
Coordinates various levels of physician reviews.*
Monitors appropriateness of level of care for assigned patients and advises clinical and medical staff when transfer to less or more restrictive level of care seems appropriate.*
Provides for appropriate response to denials for continued stay.*
Provides clinical services as assigned and within scope of licensure and clinical competency.*
Maintains UM related data and statistics.*
Qualifications:
EXPERIENCE

Required:
Minimum 2-5 years behavioral health clinical experience commensurate with educational level.

Preferred:
Acute care behavioral health experience. Recent experience with QM, UM, commercial pre-certification and discharge planning.

EDUCATION

Required:
Graduation from a professional school of nursing, counseling, psychology or social work.

Preferred:
BSN or Masters degree in nursing, social work, counseling or psychology.

LICENSURE

Required:
Current RN license; eligible for licensure in the state of Virginia for LPC, LCSW.

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