Job Description

This position is responsible for the development and administration of centralized processes for facilitating adult inpatient admissions and pre-authorizations for hospitalization, and for effective case management and liaison with payors for authorizations for continuing care, in a manner that will ensure quality patient care while maximizing reimbursement for services. Provides guidance and leadership to coordinate, facilitate and expedite psychiatric social work patient care services across the mental health continuum.

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Responsible for the general oversight of adult and child referral, intake, and admissions processes.
• Develops a centralized intake system for the adult inpatient unit in the Department of Psychiatry. Creates and maintains a computerized database of referrals to the inpatient psychiatry units.
• Serves as the centralized contact for all referrals made to the Adult Inpatient Psychiatry Unit. In accordance with the established standards and criteria, and in conjunction with a multidisciplinary team, assesses appropriateness of admission measured against admission criteria for all patients referred for hospitalization to the Adult Inpatient Psychiatry Unit.
• Collaborates with the nurse manager and medical directors regarding the presentation of potential referrals for admission.
• Ensures effective continuous liaison with third-party payers regarding patient treatment in a manner that will maximize reimbursement for services. Verifies and obtains information on payor source and negotiates pre-authorization from third-party payors where applicable. Screens for patients needing referrals to the Financial Coordination Department. Documents all payor-related information in a comprehensive, organized manner. Serves as a resource for the treatment team regarding relevant payor issues. Offers supervision and consultation to treatment team members performing concurrent review with insurers. Submits written appeals to insurers when coverage is denied.
• Facilitates and expedites care within the Tufts Medical Center system. Assists Psychiatric Consult-Liaison Service with determining payor issues and obtaining pre-authorization for inpatient hospitalization to the Tufts Medical Center Inpatient Psychiatric Unit only. Coordinates the presentation of clinical information to the Adult Inpatient Psychiatry Unit for patients who are considered for transfer from a Tufts Medical Center medical service. Offers consultation and advice, in conjunction with the service-connected social worker and Quality Support Services nurse, to members of the Psychiatric Consult-Liaison team regarding discharge planning.
• Consults, collaborates and communicates with a wide range of social, governmental, legal agencies, courts, schools, clinics, other hospitals, care providers and other referring sources. Develops relationships with these sources to facilitate referrals for admission and for after-care.
• Responsible for monitoring effectiveness of admissions and referral system using data collection and outcome measurements.
• Participates in interdepartmental planning regarding program development, policy and decision-making, fiscal planning and quality assurance as required.
• Participates in various Department of Psychiatry committees, task forces, etc.
• Submits monthly and annual reports to Department administration to include information on admission and referral rates, referral sources, referral rejection rates, reasons for rejection, insurance information, and other pertinent information.
• Submits monthly data to the Department of Mental Health.
• Works in close collaboration with the Emergency Department to develop and improve systems to enhance the efficient flow of behavioral health patients and minimize wait times. Facilitates bed-finding for patients in the ER setting to outside hospitals.
• Acts as liaison to the Admissions Department to ensure an efficient and proper flow of information to expedite psychiatry admissions.
• Schedules inpatient and outpatient ECT admissions and ensures that all requirements are met including insurance verification and authorization and legal status.
• Markets the child and adult inpatient services to the healthcare community to increase patient volume.
• Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the working group’s achievement of goals, and to help foster a positive work environment.
• Performs other similar job related duties as required or directed.

Qualifications

JOB KNOWLEDGE AND SKILLS:

• High-level diagnostic, treatment, interpersonal, organizational and communication skills.
• Excellent negotiation skills with well-developed problem-solving abilities.
• Knowledge of regulatory requirements, managed mental health continuum of care, inpatient child and adult psychiatry, quality assurance, knowledge of governmental and community agencies and systems of care, including DDS, DMH, DMR, DCF, etc.
• Computer skills and knowledge of general office programs, spreadsheet programs, database and presentation programs (Word, Excel, Access, PowerPoint).

EDUCATION:

• Masters Degree in Social Work, counseling, or related field from an accredited institution.

EXPERIENCE:

• 3-5 years post-Masters degree clinical experience in psychiatry working with inpatients and/or psychiatric emergency services in a managed care environment. Experience should demonstrate high level of interpersonal and communication skills, both oral and written; good organizational skills and ability to work effectively with multidisciplinary teams.
• An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

LICENSES, ETC.:

• Licensure at the Licensed Independent Clinical Social Worker (LICSW) level by the Commonwealth of Massachusetts, or Licensed Mental Health Counselor (LMHC).

WORKING CONDITIONS/PHYSICAL DEMANDS:

• 1. Hospital patient care areas- Psychiatric Unit, Emergency Department, Medical/Surgical Floors.
• 2. Normal office work environment.

Additional Information

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.