Company: Oceans Healthcare
Posted on: January 13, 2022
Oceans Behavioral Hospital Pasadena, healing is our focus. We
are passionate about helping adults and seniors manage the
challenges associated with anxiety, depression and other mental
health issues. Utilizing proven, innovative and progressive
therapies, our qualified professionals strive to promote long-term
wellness through a range of inpatient and outpatient psychiatric
counseling and treatment options.The Case Manager coordinates with
the admission staff and clinical staff to facilitate the meeting of
patient's treatment needs as well as management of utilization
review activities for the inpatient programs in accordance with the
Joint Commission, Federal and State regulations, Oceans' mission,
policies and procedures and Performance Improvement standards. Acts
as patient liaison for physician, clinical staff and family
member's activities. Works in coordination with the Performance
Improvement Coordinator to conducts closed and concurrent reviews
of medical records. Interacts with members of the medical/clinical
team to provide a flow of communication, ensure criteria for
admission and continued stay are met and that the medical record
documentation supports the level and intensity of service rendered
as well as facilitating timely discharge planning. Works with the
primary therapist and nursing staff to facilitate treatment
planning documentation, family contact, scheduling appointments,
absentees from programming and access to community resources.
- Functions as patient liaison in the role of case manager to
coordinate patient treatments with the physician, therapist and
- Compiles psychosocial data and scribes on form; completes
integration of assessment and presents to multi-disciplinary
treatment team for review and approval; Schedules appointments,
follows up on absentees and completes continuing care plans.
- Attends treatment team meetings and communicates case
management activities to the other team members.
- Identifies and reports appropriate use under-use, overuse and
inefficient use of services and resources to ensure high quality
patient care is provided in the least restrictive environment and
in a cost-effective manner.
- Conducts review, when needed, of records in a timely manner to
(1) determine appropriateness and clinical necessity of admissions,
continued stay, and/or rehabilitation, and discharge; (2) determine
timeliness of assessments and evaluations; i.e., H&Ps,
psychiatric evaluations, CIA formulation and discharge summaries;
and (3) identify any under-, over- and/or inefficient use of
services or resource.
- Notifies appropriate staff members of any deficiencies noted so
corrective actions can be taken in a timely manner; submits monthly
report to PI Coordinator of findings and actions recommended to
correct identified problems.
- Coordinates flow of communication between physician/staff and
third-party payers concerning reimbursement requisites.
- Attends status meetings to communicate third party payer
status, update attendance calendar and communicate individual
patient needs to clinical and admission staff. Shares pertinent
- Initiates and completes appeals process for reimbursement
denials; notifies inpatients of denials received; notifies
physicians/staff/patients of reimbursement issues.
- Upon notification by business office that potential exists to
be included on a new managed care contract, makes contact with the
managed care company and coordinates communications between
administrator and the managed care company to obtain contractual
arrangements. Maintains coordination of information requests from
third party payers for annual renewal or update of existing
contracts. Communicates to staff status of new/existing contracts.
- Performs additional case management duties as required and
coordinates flow of communication amend staff involved in the
patient's care; completes paperwork for judicial commitments and
state bed packets.
- Completes referral process and necessary paperwork for all
other levels of care and make follow-up appointments; including
follow-up letters needed by the patient; completes all medication
assistance forms and assists patients and families with follow-up
- Conducts special retrospective studies/audits when need is
determined by M&PS and /or other committee structure.
- Accurately does discharge reviews on 100% of all discharges per
month; accurately inputs discharge review information into computer
database; accurately send records for appeal in timely manner;
accurately completes all initial CQI+ forms and questionnaires in a
- Performs other duties and projects as
assigned.RequirementsAssociate degree with emphasis on healthcare
or bachelor's degree in social services field preferred. At least
one year psychiatric/chemical dependency experience with good
working psychiatric/medical knowledge.Must have excellent assertive
communication skills. Knowledge and in-depth understanding of
CD/psych treatment and discharge planning process. Must have good
writing and composition skills. Must have good understanding of
regulatory and fiscal reimbursement and utilization review as a
primary component of patient care. Must demonstrate strong patient
advocacy skills. Must be able to organize and prioritize high
volume workload. Must be able to analyze and utilize data and
systems to provide individualized quality treatment in a
cost-effective manner. Must be able to function with minimal
supervision. Therapeutic Intervention De-escalation Education
required. Must have ability to maintain overall good work attitude
and interact cooperatively and professionally with other staff
members and third-party payers to achieve mutually beneficial
outcome. Must possess basic competency in age/disability/cultural
diversity needs of patients served and ability to relate to
patients in a manner sensitive to those needs. Must successfully
complete CPR certification and an Oceans approved behavioral health
de-escalation program.Subject to many interruptions. Occasional
pressure due to multiple calls and inquiries. This position can be
high paced and stressful; must be able to cope mentally and
physically to atmosphere. This person might sometimes experience
disagreeable odors, sights and/or unpredictable patient behavior.
Work requires spending approximately 90% or more of the time inside
a building that offers protection from weather conditions but not
necessarily from temperature changes.
Keywords: Oceans Healthcare, Pasadena , Case Manager, Executive , Pasadena, Texas
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