Behavioral Health – Case Manager

Texas Health Resources

15d • Remote

About The Position

Behavioral Health – Case Manager Bring your passion to THR so we are Better + Together Work location: Texas Health Resources – Behavioral Health, Remote Work hours: Full-time (40hours) Monday – Friday 9:00AM – 5:00PM

Requirements

• Master's Degree Counseling or Social Work Required
• 3 Years Clinical psychiatric or chemical dependency experience Required
• 6 Months in case management or utilization review Required
• Prior experience with EPIC EMR
• LMSW - Licensed Master Social Worker Upon Hire Required
• LCSW - Licensed Clinical Social Worker Upon Hire Required
• LPC - Licensed Professional Counselor Upon Hire Required
• LPC-A - Licensed Professional Counselor Associate Upon Hire Required
• CPR - Cardiopulmonary Resuscitation prior to providing independent patient care and maintained every 2 years Upon Hire Required

Nice To Haves

• ACPI - Advanced Crisis Prevention Intervention Training Upon Hire Preferred

Responsibilities

• Identifies those cases requiring certification or re-certification for third party payors. Ensures reviews are initiated on all patients; conducts reviews on admission, continued stay and discharge as defined in behavioral health policies.
• Reviews the treatment plan and advocate for additional services as indicated.
• Consults with the business office and/or admissions staff as needed to clarify data and ensure the insurance precertification process is complete.
• Reviews records of patients according to approved criteria. Verifies appropriateness of the admission, continued stay and concurrence with government/third party payor regulations. Documents all actions per required processes. Notifies supervisor if patient is not meeting criteria.
• Refers cases that do not meet criteria to supervisor, attending physician and other members of the treatment team as appropriate.
• Records are maintained for all reviews completed. This will include documenting all activity with the third-party payor and notes the number of certified days, dates of contact, authorization codes, and reference numbers for approval/disapproval.
• Ensures the appropriateness of hospitalization or continued hospitalization in accordance with approved criteria.
• Records of criteria and correspondence with external agencies and insurance companies are maintained for reference.
• Attends multidisciplinary treatment team.
• Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.
• Provides timely feedback to the attending physician and treatment team members concerning continuing certification of days/service
• Collaborates with the treatment team and supervisor regarding continued stay and discharge planning issues.
• Ensures coordination of benefits regarding continuity of care decisions.
• Recommends and promotes discharge planning activities that reflect patient medical necessity needs and third-party payor authorization.
• Coordinates discharge planning as needed between the third-party payor and discharge planner(s).
• Maintains current awareness of mental health activities in the community.
• Maintains an awareness of community and market-related activities which includes knowledge of the activities of other providers, needs of local payors, and the political climate related to mental health.
• Remain current on all clinical techniques and age-related mental health competencies and provide direction to staff and facility personnel as needed.
• Attends other hospital committees, task force meetings, and participates in Continuous Improvement (CI) teams as assigned.
• Effectiveness and quality of the services provided by the organization are enhanced.
• Utilization management issues are identified and addressed by the appropriate individuals/committees
• Maintains current knowledge of Medicare, federal and state regulatory requirements for documentation, record keeping, and patient rights.
• Any observed deficiencies in Medicare, federal and state regulatory requirements are reported to supervisor and Administrative leaders as appropriate.
• Potential utilization management issues are addressed with supervisor and administration leaders as necessary to ensure the most appropriate use of the hospital's resources.
• The admission and continued hospitalization of third-party payor patients are appropriate and authorized.
• Recognizes and communicates ethical and legal concerns through established channels of communication.
• Action taken to protect patient rights and/or preferences and promote patient desired outcomes.
• Patient advocacy role demonstrated and documented when appropriate.
• Maintains confidentiality of facility employees and patient information
• Provides and accepts constructive feedback in a calm, respectful manner.
• Code White, HIPAA, BLS/CPR, 1 hour each adolescent/adult/geriatric age-specific training, ethics training, Care Connect updates and training, and continuing education required for license completed annually
• Education record maintained.
• Treats all staff courteously.
• Maintains professional accountability.
• Complies with personnel policies, i.e. Attendance Policy, Dress Code, Social Work Practice Act, etc.
• Licensure and certifications maintained as required.
• Takes responsibility to manage time and resources.
• Utilizes professional judgement to consistently prioritize daily workflow
• Adapts to changes in workload by demonstrating flexibility in UR needs.
• Coordinates efficient communications with payor and customer stakeholders
• Complies with reimbursement related standards
• Identifies ineffective and costly processes and provides suggestions for improvement
• Utilizes resources cost effectively
• Reviews denial work queues and denial documentation activities on a routine basis
• All denied behavioral health claims are reviewed and appealed when appropriate to third-party payors.
• Maintains current knowledge of appeal policies and procedures for third party payors.
• Documents ongoing efforts to resolve unpaid claims.
• Coordinates with the insurance company physicians in appeals, expedited appeals, or denial process as necessary.
• Maintains ongoing contact and collaboration with the CBO, billing and coding departments.

Benefits

• Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program as well as several other benefits.
• At Texas Health, our people make this a great place to work every day. Our inclusive, supportive, people-first, excellence-driven culture make us a great place to work.
• A supportive, team environment with outstanding opportunities for growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees