Coordinates systems and services with an organized,trans-disciplinary team approach which delivers quality, cost-efficient care topatients through the continuum of health care services. Appropriateness ofadmission and continued stay reviews are conducted concurrently orretrospectively. Collaborate with the patient, family and other members of thehealth care delivery team to facilitate appropriate movement through the carecontinuum as demonstrated through quality outcomes. Works effectively withinternal and external customers and proactively improves case managementprocesses. Provides direct input to St. Anthony Hospital annual UtilizationManagement/Case Management/Performance Improvement Plans and is accountable forthe successful completion of the action plan developed.
Assess data to determine medical necessity and appropriateness of level of care/admission based on approved criteria. Complete insurance verification and authorizations for specific pt population from preadmission through discharge.
Manage patient's benefits by checking insurance eligibility to optimize payment of services rendered for alternative cost-effective levels of care. Notify physician, business office, and patient/family of insurance denials.
Attend weekly treatment team meetings with physicians, therapists, and nursing staff to discuss treatment options, benefits, insurance authorizations, and discharge planning.
Collect, record, and maintain clinical information gathered from concurrent or retrospective review and assess for medical necessity criteria. Utilize EPIC for documentation purposes.
Display self-motivation through designing, planning, and initiating work processes and activities with minimal supervision. Attends and actively participates in departmental, hospital and medical staff meetings as assigned.
Familiarize self with all behavioral medicine units and is cross-trained to provide services in case management for each unit including in patient and day treatment.
Perform other related duties as directed that correspond to the overall function of this position.
Bachelor's degree or Master's degree in mentalhealth, business, or other health care related field required.
Skills and proficiency in applying highlytechnical principles, concepts, and techniques central to the health care profession.Knowledge of computer software and hardware application ad basic knowledge ofstatistics.
Current CPR (Heartsaver).
Must be 21 years of age. Any unit specifictraining must be completed in accordance with the unit policies and procedures.
Licensure or registration by appropriateprofessional certifying body preferred.
St. Anthony Hospital –
St. Anthony Hospital is a 601-bed regional referral facilityspecializing in cardiology, oncology, surgery and behavioral medicine. Thehospital, established in 1898, is located in Midtown Oklahoma City and servesthe needs of Central Oklahoma, as well as many counties throughout Oklahoma,through its large rural affiliate network of hospitals. Four St. AnthonyHealthplex campuses provide convenient emergency and outpatient service accessto the outlying communities of the metropolitan area. St. Anthony added urgentcare services in May 2015 at St. Anthony North. St. Anthony has receivednumerous awards including the Oklahoma Quality Award for Excellence, CertifiedHealthy Business, Premier QUEST® Award for High-value Healthcare Citation ofMerit, among others. Healthsights ranks St. Anthony at performance levels forquality and patient satisfaction higher than local competitors and manynational health care organizations.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same