Utilization Management Case Manager- Per Diem (Hybrid)
About The Position
The Utilization Management Case Manager- Per Diem (Hybrid) has responsibility for organizing and conducting the managed 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 continued 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's degree from an accredited college or university in social work, counseling or nursing; or a bachelor's degree from an accredited college or university in social work or counseling or similar health sciences field is highly desirable.
- Unrestricted limited or full licensed (LBSW, RN, LLMSW, LMSW, LLP, LP, LPC, LMFT, etc.)
- Two (2) years of related experience, with knowledge of psychiatric patient care techniques with understanding of mental illness, preferred.
Nice To Haves
- Knowledge of psychiatric patient care techniques with understanding of mental illness.
Responsibilities
- Conducting timely admission and continued 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.
- Acting as liaison with MD/Clinical Treatment Team and external agencies.
- Reporting authorizations, denials, and documentation concerns.
- Collaborating effectively across departments to minimize denials/facilitate optimal use of hospital resources.
Benefits
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
