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Coordinates utilization review activities for the purpose of monitoring standards of patient care and to take action to improve care and maintain quality care.
Work is performed in accordance with established professional policy, procedures, practices, regulatory requirements and accrediting body standards.
Provides professional nursing care to clients in the ACT Program.
Directs and supervises activities and assignments of ancillary personnel to the ACT Program.
Is responsible for providing a broad range of treatment and rehabilitation activities.
Minimum qualifications
Education, certification, and/Or licensure
1. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
2. Obtain certification in Basic Life Support within 30 days of hire date.
3. State criminal background check and Federal (if applicable), as required for regulated areas.
Experience
1. Two (2) years clinical experience in mental health field.
Preferred qualifications
Experience
1. One (1) year utilization review experience.
Core duties and responsibilities
The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Conducts initial clinical assessment of the patient at the time of admission to determine medical necessity using established admission criteria.
2. Performs concurrent and retrospective reviews with all third party payers consistent with their time frames and individual criteria.
3. Coordinates all aspects of the certification process to ensure that proper reimbursement is attainable. This includes pre-certifications, continued stay reviews, appeals, and any associated paperwork.
4. Facilitates ongoing education of house staff regarding proper documentation techniques.
5. Is the ACT Program’s advocate in a liaison relationship with third party payers and regulatory agencies.
6. Assures that all aspects of the medical record meet established hospital and accrediting agency standards.
7. Consistently protects the confidentiality of all clinical data relating to patients, physicians, and personnel.
8. Coordinates all quality assurance activities relevant to patient care, treatment planning and program evaluation.
9. Responsible for continued professional development in current utilization review standards and practices.
10. Collects and records data that is comprehensive, accurate and systematic, on the nursing and psychosocial assessment forms and in progress notes. Correlates all assembled data on the psychosocial assessment and history in a manner that is clinically pertinent to the individual patient.
11. Bases decisions made/actions taken on relevant scientific principles, established standards of care and/or research findings.
12. Utilizes nursing diagnoses and/or standards classification of mental disorders to express conclusions supported by recorded assessment data and current scientific premises.
13. Assesses and documents in the medical record the biopsychosocial needs of the patient, according to the developmental age of the patient.
14. Participates in treatment planning sessions by assisting in development of master treatment plan with specific goals and interventions delineating nursing and social work actions unique to each client’s needs and developmental age. Assists in determining appropriateness of admissions and receives referrals for social work intervention.
15. Intervenes as guided by the master treatment plan to implement nursing actions that promote, maintain or restore physical and mental health, present illness and effect rehabilitation.
16. Performs discharge planning as developed with the treatment team from day of admission. Acts as liaison for ACT Program patients and their families to various community agencies, hospital consultant and services.
17. Assists patients and families in achieving a satisfying and productive pattern of living through health teaching, and documents teaching according to hospital policy. Provides group therapy as deemed appropriate by the psychiatrist and Manager.
18. Establishes and maintains a therapeutic milieu in collaboration with the patient and other health care providers, taking developmental age of patient into account. This includes but is not limited to providing care to patients in a manner that considers safety, patient rights, and comfort. Setting limits in a therapeutic and consistent manner on a patient’s behavior within program guidelines and identification of verbal and non-verbal cues of potential aggressive behavior and application of de-escalation techniques to situations, are involved in maintenance of therapeutic milieu.
19. Determines the developmental age (level of development) on each patient and assists the treatment team in the development and implementation of a treatment plan specific with developmental needs and/or required intervention.
Physical requirements
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Working environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Additional
Job Description
Scheduled Weekly Hours: 40
Shift
Exempt/Non-Exempt: United States of America (Non-Exempt)
Company
USC Healthy Minds
Cost Center
3067 USC Act Program II
Address: 37 Elizabeth Dr
Weston
West Virginia
Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
