UM Case Manager
About The Position
The Utilization Management Case Manager has a responsibility for organizing and conducting the manager care process. These duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to ): conducting timely admission and continues stay record reviews with external payers, utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively across departments to minimize denials/facilitate optimal use of hospital resources.
Requirements
- Bachelor Degree in social work, psychology, counseling or nursing required.
- Limited or fully licensed (LBSW, RN, LLMSW, LLP, TLLP, LPC, LMFT, etc.).
- A minimum of 2 years of post-graduate related experience in psychiatric or substance abuse treatment required.
Nice To Haves
- Master's degree in social work, psychology, or counseling preferred.
- Hospital utilization review/utilization management experience preferred.
- Familiarity with manager health care process, medical terminology, experience in case management, discharge planning, and/or utilization review preferred.
Responsibilities
- Through clinical skills (experience and knowledge), reports to external insurance and review entities an accurate presentation of the medical management of a patient's illness, length of stay and care alternatives available within the confines on the client's benefits and financial resources.
- Communicates with the Treatment Team (physicians, nursing staff, social workers, etc.) as necessary to advocate for the patient's clinical treatment within the confines on the client's benefits and financial resources.
- Using clinical skills (experience and knowledge) assists the team in ensuring the completeness and accuracy of the medical records.
- Performs other related duties as assigned.
Benefits
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plan
- 401(K) with company match and discounted stock plan
- Career development opportunities within UHS and its 300+ Subsidiaries
- Free Basic Life Insurance
- Tuition Reimbursement
- SoFi Student Loan Refinancing Program
- Student Loan Repayment Program - for some degrees and criteria
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
