Utilization Review/Case Manager

Freedom Behavioral Hospital of Monroe•Claiborne, LA

1d•$18 - $22

About The Position

The Utilization Review/Case Manager coordinates patient care services and manages utilization review functions to support appropriate levels of care, timely insurance authorization, and effective discharge planning. The role is the primary liaison among the hospital, payors, patients, families, and referral partners, supporting clinical and financial outcomes. In accordance with The Joint Commission standards, federal and state regulations, Freedom’s mission and policies, and its Performance Improvement (PI) program, the Case Manager facilitates the continuum of care from admission through discharge.

Requirements

Strong understanding of behavioral health levels of care, medical necessity criteria, and insurance authorization processes.
Ability to communicate effectively and professionally with multidisciplinary teams, payors, patients, and families.
Excellent organizational, documentation, and time-management skills.
Knowledge of regulatory and accreditation standards related to case management and utilization review.
Ability to manage multiple priorities while maintaining accuracy and compliance.

Responsibilities

Coordinate with Admissions and Clinical staff to identify and meet patient treatment needs throughout the stay.
Conduct utilization review activities, including obtaining initial and continued-stay authorizations from insurance providers.
Serve as the primary point of contact with payors, communicating medical necessity, level of care, and continued-stay criteria.
Develop, implement, and manage discharge plans to support safe and appropriate transitions of care.
Communicate with patients, families, and referral sources to support positive treatment outcomes.
Gather and present clinical information to the multidisciplinary treatment team and participate in treatment team meetings.
Maintain communication with physicians, nursing, social services, and other disciplines to coordinate care delivery.
Document utilization review and discharge planning activities accurately and promptly in the medical record, supporting intensity of service and medical necessity.
Collaborate with external agencies and providers to coordinate aftercare services and continuity of care.
Uphold patient rights, ethical standards, and confidentiality.
Participate in Performance Improvement (PI) and Quality Management (QM) activities, including data collection and process improvement initiatives.