Behavioral Health RN Care Coordinator

Johnson Memorial Health; Franklin (IN); On-site; USD 70,000 - 90,000; Full time

Job summary

Johnson Memorial Health in Franklin, IN seeks a Behavioral Health RN Case Manager to assess patient records, coordinate care, and secure timely insurance certification and discharge planning. The role requires a BSN and Indiana RN licensure with at least 1 year in behavioral health. Certification and managed care knowledge are preferred.

Schedule is Monday–Friday, 8:00 a.m. – 4:00 p.m., 75 hours biweekly. The incumbent will work with Interqual criteria, collaborate with the care team, and ensure

Qualifications

• BSN required.
• Current Indiana RN licensure in good standing required.
• One year experience in behavioral health is required.
• One year experience in case review in a hospital acute care setting is preferred.
• Clinical pathway experience and certification in Case Management preferred.
• Must be familiar with managed care, Medicare, and Medicaid guidelines, along with precertification, concurrent and retrospective review.
• Experience with HFAP/ACHC accreditation preferred.

Responsibilities

• Assess and analyze the patient’s record according to pre-established criteria for severity of illness and intensity of services provided.
• Compare data from the patient record to criteria and collaborate with the healthcare team to assure appropriate utilization of services.
• Serve as consultant to the provider, assuring proper placement within the continuum of care.
• Complete reviews accurately and timely, using Interqual criteria.
• Monitor observation stays and ensure inpatient admission when criteria are met, or discharge from observation status as soon as possible.
• Screen for Medical Staff quality issues using criteria set by Medical Staff.
• Review insurance verification information in EMR and determine what medical information is required for certification of stay/services.
• Obtain certification from insurance companies for patient stays and discharges; contact insurers for information needed to facilitate discharge.
• Assess health status of patients by collecting data and evaluating nursing, medical and ancillary care.
• Evaluate potential for safe discharge to home and document the discharge plan ensuring regulatory compliance.
• Track faxes to insurers to ensure certification information is received.
• Review EMR for additional information needed by insurers and follow up.
• Track patients discharged and fax discharge information; obtain/certify for discharges.
• Coordinate services for complex cases and provide discharge options and referrals to community resources.
• Ensure collaborative planning with patient, family, and healthcare team throughout continuum of care.
• Consult with care team to address barriers and facilitate process changes to improve outcomes.
• Notify Social Services for inpatient/observation issues and arrange interdisciplinary care conferences.
• Track and assist staff to obtain signatures on forms to facilitate discharge.
• Develop educational materials for patients and families with discharge resources.
• Monitor resource use to achieve patient outcomes and reduce length of stay.
• Counsel patients/families on Medicaid Prudent Lay Person and financial options; refer to Claim Aid.
• Serve as liaison with third party payer for authorization/certification.
• Participate in performance improvement initiatives and report findings to stakeholders.
• Work with diverse ages, races and backgrounds.
• Perform additional related duties as assigned.

Education

BSN

Indiana RN licensure

1 year behavioral health experience

Case management certification

HFAP/ACHC accreditation experience

Job description

Johnson Memorial Health in Franklin, IN seeks a Behavioral Health RN Case Manager to assess patient records, coordinate care, and secure timely insurance certification and discharge planning. The role requires a BSN and Indiana RN licensure with at least 1 year in behavioral health. Certification and managed care knowledge are preferred.

Schedule is Monday–Friday, 8:00 a.m. – 4:00 p.m., 75 hours biweekly. The incumbent will work with Interqual criteria, collaborate with the care team, and ensure