Utilization Review - Behavioral Health (Hybrid)

Description

Work where every moment matters.

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here.  We invite you to become part of Connecticut’s most comprehensive healthcare network. 

St. Vincent’s Medical Center in Bridgeport has more than 3,200 employees. It includes a 473-bed community teaching hospital, a 76-bed inpatient psychiatric facility in Westport, a large multispecialty provider group, and special needs services for adults and children. St. Vincent’s is the first hospital in Fairfield County to be integrated into the Hartford HealthCare network, and is the system’s second-largest hospital.

Job Summary:
• Coordinates the overall interdisciplinary plan of care for patient, from admission to discharge.
Responsibilities:
• Creates plan for care across the continuum, integrating patient/family preferences and values.
• Monitors patient care through assessments, evaluations and/or patient records.
• Advocates for resources and removal of barriers.
• Maintains ongoing dialog with supervisor and other health providers to ensure effective implementation of health plan.
• Acts as a resource for adequate medical record documentation, appropriateness of services as they relate to diagnoses, and treatment options for post-discharge care.
• Maintains working knowledge of insurance companies, authorization and treatment requirements and expectations. Maintains a resource of most commonly utilized insurance providers.
• Works with the chair of the department and the Director of Care Management to develop standards and education around medical necessity.
• Provide education to employees around medical necessity and supporting documentation as indicated from regulatory standards.
• Works to facilitate insurance reviews/appeals when treatment is denied or needs a more extensive review process.
• Other Duties as assigned

Qualifications

Licensure / Certification / Registration:
• Preferred Credential(s):
• Licensed Counselor specializing in Alcohol and Drug Abuse credentialed from the Connecticut Department of Public Health.
• Licensed Counselor specializing in Marriage & Family credentialed from the Connecticut Department of Public Health.
• Licensed Counselor specializing in Mental Health credentialed from the Connecticut Department of Public Health.
• Licensed Psychologist credentialed from the Connecticut Department of Public Health.
• Licensed Social Worker credentialed from the Connecticut Department of Public Health.
Education:
• Masters degree in Social Work, Counseling, Psychology or related field. Licensure preferred. Or registered nurse with experience listed above. 3 years’ experience in a mental health setting, preferably on an inpatient unit required. (internship experience acceptable) One year experience providing care management/insurance reviews in mental health setting required.
We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.