Clinical Utilization Case Manager
About The Position
The Clinical Utilization Case Manager serves as the clinical link between the treatment team, the Center, and external payors and case management entities. The position supports justification for continued residential treatment (RTC), ensures clinical documentation is accurate and complete, and maintains case files in accordance with regulatory agency and managed care company requirements. The ideal candidate is organized and independent, can translate quality care into clear, payor-ready documentation, and is committed to supporting military-connected youth and their families. This is a full-time, on-site position at Barry Robinson Center in Norfolk, Virginia. Working hours are Monday through Friday, 8:30 a.m. to 5:00 p.m. The stated salary range is $55,000 to $60,000 per year.
Requirements
- Minimum of 1 year of clinical experience in an inpatient mental health setting.
- Ability to manage a caseload of at least 30 clients and meet critical submission deadlines.
- Strong writing, proofreading, organizational, and time management skills; ability to work independently and set priorities.
- Ability to apply payor criteria to clinical information and write appropriate narrative reports.
- Quantitative skills to prepare statistical data and reports.
- Sensitivity to report content and liability issues.
- Proficiency in Microsoft Office, including Outlook, PowerPoint, and Excel.
- Familiarity with EMRs and payor portals.
Nice To Haves
- Active LPN or RN licensure.
- BA/BS in a Human Services field.
- Payor experience.
Responsibilities
- Communicate with payors and case management companies, submitting documentation to justify the authorized level of care by required deadlines.
- Conduct ongoing utilization review of paper and electronic records to support medical necessity for continued RTC care, and submit updated clinical status reports according to payor guidelines.
- Monitor service delivery for consistency with payor criteria and report issues that could trigger an audit or jeopardize authorization to the supervisor.
- Verify that treatment plans and staffing reports are accurate and include all payor-required elements.
- Review treatment plan problem areas and goals to report client progress to payors.
- Work with the treatment team monthly, in person or via Zoom, Teams, or Outlook, to update reviews and goals and recommend solutions.
- Collect and assess data for QI monitoring, suggest improvements, and report documentation issues to HIM and the responsible department.
- Partner with departments and outside providers to ensure documentation is complete and to secure discharge and step-down support.
- Complete the payor-required discharge summary within the required timeframe for case close-out.
Benefits
- Medical, dental, and vision insurance.
- 403(b) retirement plan with company contribution.
- Company-paid life and long-term disability insurance.
- Paid annual leave (vacation).
- Paid sick leave.
- Eight paid holidays.
- Tuition reimbursement: $3,000 per calendar year after 6 months of tenure and $5,000 per calendar year after 2 years of tenure.
- Public Service Loan Forgiveness (PSLF)-eligible nonprofit organization.
- Employee Assistance Program (EAP).
- Annual performance reviews.
- Employee events and activities.
- Opportunities for advancement.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
