Behavioral Health PHP/IOP

Company: Ohio State University Wexner Medical Center
Location: Columbus
Posted on: January 24, 2025

Job Description:

Scope of PositionHarding Hospital and The Ohio State University Wexner Medical Center are committed to enhancing the quality of care our patients receive. Our hospital is a multi-disciplinary Academic Center for Excellence providing behavior health inpatient, partial, outpatient, emergency, and consultation services to adults. The OSU Harding Hospital PHP/IOP Patient Care Resource Manager, PCRM, facilitates inpatients and outpatients through the health care system to include pre-admission through post discharge coordination of care, resources and services of all OSU Behavioral Health Service lines with a primary focus on OSU Harding Hospital Behavioral Health Partial hospitalization and intensive outpatient programs. OSU Harding Hospital Behavioral Health Partial hospitalization and intensive outpatient programs are therapeutic treatment experiences for individuals who require more than the conventional outpatient level of care but do not need the security of a locked unit or 24-hour care. These programs can act as a bridge to help a person transition from an inpatient setting to an outpatient community setting for treatment. They can also assist a person who is struggling to cope with their symptoms with outpatient therapy alone, but does not require inpatient hospitalization. These programs are designed to treat a variety of psychiatric illnesses using group psychotherapy, psychopharmacology, psychoeducation and individual psychotherapy.We currently offer multiple levels of care, allowing staff to develop and provide a specifically designed individualized treatment program. We meet with each potential patient to assess which level of care would be most beneficial. Family and friends are included in all stages of the treatment process as often as possible and as deemed appropriate.Position SummaryThe Psychiatric Patient Care Resource Manager (PCRM) for the OSU Harding Hospital Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) monitors and coordinates the patient plan of care to improve the timeliness of care decisions, enhance throughput, and ensure quality and efficiency while optimizing resource utilization. The PCRM identifies and resolves barriers to the progression of care plans, collaborating with physicians, Behavioral Health Clinicians, Advanced Practice Providers (APPs), Occupational Therapists (OTs), nurses, and other healthcare professionals to manage patient entry and transitions to subsequent care levels.As the central information source for third-party payers, the PCRM communicates the plan of care, establishes medical necessity, and secures prior and ongoing authorization for treatment. Using evidence-based criteria, the PCRM assists providers in ensuring the appropriate level of care for each patient and proactively responds to state and national healthcare trends with initiatives to enhance care delivery and resource efficiency. Additionally, the PCRM educates and consults with medical and behavioral health providers, patients, and families regarding behavioral health regulations, criteria, funding, and resources, highlighting distinctions from the general medical healthcare system. PCRMs collaborate with colleagues across behavioral health levels of care and provide cross-coverage when needed.The PCRM supports the PHP/IOP intake and treatment process, including triaging referral source calls, collecting pre-admission demographic, clinical, and payer information, verifying insurance benefits and eligibility, securing pre-certifications and authorizations, and managing the registration, admission, and discharge processes. The PCRM also performs clinical utilization reviews and coordinates with third-party payers to manage patient cases from pre-admission through post-discharge, ensuring a seamless transition of care and access to necessary resources.In addition to facilitating peer-to-peer reviews and addressing payer denials, the PCRM supports treatment and discharge planning by assisting PHP/IOP clinicians, attendings, APPs, and other PHP/IOP affiliated staff in locating in-network providers, making referrals, initiating insurance authorizations, and scheduling follow-up appointments. The PCRM is a key educator for behavioral health payers, providers, and the public, ensuring clarity and consistency in the care process.Maintaining an awareness of state and national behavioral health trends, the PCRM proactively implements initiatives to enhance care provision and resource utilization. The role involves active collaboration with other Psychiatric Care Utilization Managers across behavioral health service lines, offering cross-coverage as needed.Minimum QualificationsFor Hire: Bachelors degree required, masters in social work, Counseling, or related field preferred. Current LSW or LPC in State of Ohio required; 2-5 years recent clinical amp;/or administrative experience applicable to the population preferred; knowledge of behavioral health clinical practice guidelines, computer data bases, and behavioral health payer protocols desired.Ongoing - Maintain licensure(s), credentials and CBLs. Practice within the parameters of the appropriate State of Ohio Professional Licensing Board.

Keywords: Ohio State University Wexner Medical Center, Middletown , Behavioral Health PHP/IOP, IT / Software / Systems , Columbus, Ohio