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Utilization Management Reviewer

Mental Health Resource Center

Jacksonville, Florida

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JOB DETAILS
SKILLS
Behavioral Health, Case Management, Child and Youth Services, Clinical Medicine, Communication Skills, Community Providers, Community and Social Services, Cross-Functional, Dental Insurance, Disability Insurance, Emergency Services, Employee Assistance Plan, Employee Relations, Flexible Spending Accounts, Healthcare, Hospital, Hospital Administration, Licensed Practical Nurse/Licensed Vocational Nurse, Life Insurance, Medicaid, Medical Records, Medications, Nonprofit, Nursing, Nursing Credentials, Outpatient Care, Patient Care, Psychiatric Nursing, Psychiatric Rehabilitation, Psychiatry and Mental Health, Psychology, Quality of Care, Registered Nurse (RN), Reporting Skills, Resource Utilization, Social Work, Team Player, Third-Party Payer, Utilization Management, Vision Plan
LOCATION
Jacksonville, Florida
POSTED
3 days ago
Benefits/Perks
  • Medical, Dental, and Vision Insurance
  • Life Insurance
  • Disability Insurance
  • 403b
  • PTO
  • Paid Holidays
  • Flexible Spending Account
  • Employee Assistance Program
Company Overview
Mental Health Resource Center is a not-for-profit Florida corporation that provides a wide range of mental health and behavioral health care services to the community such as 24-hour emergency services, inpatient psychiatric services for children, adolescents, and adults as well as outpatient services such as medication management, case management, and counseling.

Job Summary
Mental Health Resource Center is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC), using predetermined criteria, review of medical records, and regular participation in treatment team meetings.

The crisis stabilization units provide services for adults, adolescents, and children. Most patients are admitted involuntarily to the facility via the Baker Act, the mental health act of Florida. The normal length of stay on the unit for patients is typically 3-5 days. Due to the types of services provided, crisis stabilization units are a fast paced working environment and present employees with challenging and rewarding opportunities. Employees work together and support one another in a friendly, team oriented atmosphere.

Responsibilities 
  • Reviews medical records and attends treatment team meetings to review utilization of resources and the level of care provided.  Ensures utilization and level of care are appropriate based on the diagnosis, needs, age and culture of the individual.
  • Carries out appropriate telephone and written communication with insurers and third party payers regarding referrals, admissions, medication changes, discharges and changes in level of care.
  • Coordinates on-site review of medical records with reviewers from third party payers.
  • Documents, updates, and manages patient and provider information using internal electronic records system.
  • Coordinates psychiatric consultations between internal and external providers.
  • Investigates complaints, grievances, and medication variances.  Reports findings to Utilization Management Manager and completes necessary follow up.
  • Responds to changing needs of the departments (i.e., program design, forms development, reporting mechanisms, etc).Establishes and maintains effective working relationships with staff members to assure professional interactions.
Qualifications
In order to be considered candidates must have one of the following: 
  • Registered Nurse: Associate Degree in Nursing required.  
  • One year experience in psychiatric nursing required. Valid Florida RN License required.
OR
  • Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required.
  • Two years experience in psychiatric nursing required. Valid Florida LPN License required.
OR
  • Master’s degree in Psychology or Human Services related field required.  
  • Three years experience in the mental health field required. UM experience preferred. 
Requires telephone and person-to-person interactions with individuals with mental illness on locked inpatient units.

Excellent communication skills are essential and this individual must be able to interact appropriately with internal and external customers, including families, caregivers, community service providers, supervisory staff and other department professionals.

Each employee contributes to the completeness and confidentiality of clinical records by ensuring documentation, paperwork and system entries meet internal and external guidelines for content, accuracy and timeliness.

Position Details
This is a full time position, Monday through Friday, 7:00am to 3:30pm

Renaissance Behavioral Health Systems and Mental Health Resource Center are Equal Opportunity Employers.
Background screening and clearance through the Florida Care Provider Background Screening Clearinghouse is required for all positions: https://info.flclearinghouse.com




About the Company

M

Mental Health Resource Center

Renaissance Behavioral Health Systems

RBHS functions as a management services organization, providing centralized administrative, finance and accounting, human resources, information technology and quality improvement services to MHRC.  Through its administrative function, RBHS coordinates the programs and services of MHRC to create an integrated, high quality service delivery system.

Mental Health Resource Center

Founded in Jacksonville in May 1977, Mental Health Resource Center, Inc. (MHRC) is a Florida not-for-profit corporation that provides a wide range of behavioral health and social services to the community.  Included in MHRC’s service array are 24-hour emergency services; inpatient psychiatric services for children, adolescents and adults; and numerous outpatient services, including medication management, case management, counseling, supported housing, psychosocial rehabilitation, two programs for the homeless, a therapeutic family program, state hospital liaison services, forensic services, in-jail services, and nine Florida Assertive Community Treatment (FACT) programs for adults with severe and persistent mental illness located in Clearwater, Gainesville, Jacksonville, Kissimmee, Naples, Rockledge, Tampa, and Winter Haven. 

Since 1989, MHRC’s programs have been fully accredited by The Joint Commission.  Inpatient services are licensed by the State of Florida, Agency for Health Care Administration.  MHRC is a certified agency of United Way of Northeast Florida.      

MHRC accepts and directly bills most insurance plans, including Medicaid, Medicare and most private insurance plans.  Individuals who do not have health insurance and cannot afford our standard rates may be eligible for a reduced fee, depending on their income and number of household members.  Some MHRC programs are funded in part by the Florida Department of Children and Families (DCF) and its managing entities, LSF Health Systems, Central Florida Behavioral Health Network, and Central Florida Cares Health System; the federal government; and the City of Jacksonville.

Mission

MHRC helps people improve their well-being and achieve their goals by providing comprehensive behavioral healthcare and social services.

Vision

We view MHRC as a leader in the behavioral health and social services field, and we will continuously strive to provide services of the highest quality and effectiveness.  Our services will be provided in the most appropriate, least restrictive setting and in the most cost-effective manner utilizing caring, professional staff.

Values

At MHRC, the core values reflect what is important to our organization.  These values guide our decisions and actions as we provide services, communicate with one another, and develop relationships within the community:

 

Integrity

We believe in ethical conduct, including honesty, fairness, and sound decision-making.

Compassion

We listen to others openly and respectfully, respond with sensitivity and understanding, and work every day to improve the lives of people in need.

Excellence

We continuously improve our communication, knowledge, and skills to provide services of the highest quality and effectiveness.

COMPANY SIZE
500 to 999 employees
INDUSTRY
Healthcare Services
WEBSITE
http://www.mhrcflorida.com/home.html

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