Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review when appropriate. Refers and consult with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay.
Facilitates optimal reimbursement through certification and denial processes.
Facilitates throughput of patients admitted urgently or emergently through the emergency department.
Participates as an active partner with multidisciplinary team members to ensure case is in the appropriate level of care setting.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
UTILIZATION REVIEW (INTERMEDIATE): - Demonstrates expertise of utilization review in practical applications of a difficult nature. Possesses sufficient knowledge, training, and experience to independently complete clinical review to obtain payor authorization. Demonstrates mastery in InterQual Level of Care Criteria and Milliam Care Guidelines. Able to train and educate by setting the example, giving technical instruction, providing leadership, and generally raising the level of performance of others while on the job.
MEDICAL TERMINOLOGY & DOCUMENTATION - (NOVICE): - Possesses sufficient fundamental proficiency to successfully demonstrate medical terminology and documentation in practical applications of moderate difficulty.
INTERDISCIPLINARY EDUCATION (NOVICE): - Seeks to provide education by collaborating with providers and other members of the health care team to ensure that the patient is placed in the appropriate level of care setting.
CLINICAL APPLICATIONS SYSTEMS (NOVICE): - Possesses fundamental proficiency in utilization review systems, clinical support systems and business support applications as needed
1 year relevant experience (Psychiatric experience preferred)
Registered Nurse License
Experience in Utilization Management is strongly preferred
Position Shift: 8a-2p with flexibility.
About Vanderbilt Psychiatric Services
Vanderbilt Behavioral Health is a multidisciplinary service within Vanderbilt University Medical Center that offers world-class patient care and excellence in education and research.
Vanderbilt Behavioral Health, through its inpatient facility Vanderbilt Psychiatric Hospital, is the only inpatient provider of mental health services for children in Middle Tennessee. We offer highly specialized services for children ages 4-12 who have emotional or behavioral challenges and need immediate assistance. Each child's care is supervised by a board-certified child psychiatrist.
Our adult programs care for patients 18 and older. We offer personalized treatment programs tailored to specific needs such as Psychotic Disorder Program, Mood Disorders Program, Addictions Programs, and the Adult Partial Hospitalization Program.
Vanderbilt Psychiatric Hospital is an 88 bed hospital for children, adolescents, and adult patients.
Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity -- of culture, thinking, learning and leading -- is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.
Our Nursing Philosophy:
We believe highly skilled and specialized nursing care is essential to Vanderbilt University Medical Center's mission of quality in patient care, education and research. We believe nursing is an applied art and science focused on helping people, families and communities reach excellent health and well-being.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period.Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As th...e largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.