GENERAL SUMMARY
Responsible for working with members who have been admitted to a clinical care facility to identify those with specific behavioral health needs to ensure the member’s needs are met upon discharge from the facility.
ESSENTIAL RESPONSIBILITIES
- Prior to discharge from clinical care facility, initiates communication with member to identify limitations and barriers that may affect member’s discharge and/or follow-up from the inpatient setting.
- Works with the health care provider to apply standard medical necessity criteria to determine the appropriate level of care following discharge from the clinical care facility.
- Gathers appropriate behavioral and physical health information that may affect the member’s response to treatment.
- Confirms with member that the discharge plan meets their needs. Assesses member’s interest and willingness to comply with additional treatment. Encourages member’s compliance to the plan.
- Ensures the first follow-up visit is scheduled within 72 hours of discharge. Verifies the name, address, and telephone number of the facility or practitioner providing follow-up care, as well as the date and time of the first appointment.
- Contacts the identified facility or practitioner following the member’s scheduled appointment to confirm compliance.
- Follows-up directly with member does not comply with scheduled follow-up treatment. Attempts to contact the member at least three times to offer assistance in rescheduling the appointment.
- Compiles and maintains documentation in member file according to standard company policies and procedures.
- Participates in quality improvement and utilization improvement activities.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Master’s prepared clinician required.
- Professional licensure preferred.
- Previous (1 year) clinical experience in the delivery of behavioral health care services, including crisis intervention and working with the chronically mentally ill.
- Previous experience working in a managed care environment preferred.
- Demonstrated written and verbal communication skills.
- Ability to use standard computer software packages and applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: St. Louis, MO, US
Organization: 51000 - MHNet Specialty Services, LLC
Schedule: Full-time
Job Posting: 2012-12-17 00:00:00.0
Job ID: 1212129