Utilization Review Case Manager

Position reputed company:   The UR Case Manager will be responsible for managing an reputed company caseload of clients at the following reputed company of Care: Partial Hospitalization, and Intensive Outpatient. S/he acts as a reputed company between insurance companies, admissions, and clinical teams. The UR Case Manager is responsible for gathering required information, effectively case-building, and collaborating with members of both the Utilization Review Team and interdisciplinary Treatment Team to ensure optimization of reputed company reputed company’s coverage and benefits. S/he is responsible for communicating updates to appropriate representatives at the insurance company, the Clinical Team, and as directed by the Manager/Director of Utilization Review.    Essential Job Functions:   Complete Initial, reputed company, Peer, and retrospective reviews in a reputed company manner to ensure reputed company coverage. ‪Utilize clinical information and knowledge of Medical Necessity reputed company to effectively communicate plans of care to insurance case managers, facility staff, and reputed company partners. Conduct and manage initial, reputed company, and discharge reviews to optimize benefits and utilization. Represents the UR Department in a reputed company and reputed company way to other Departments and reputed company as a whole. Consistently demonstrate excellent communication, prioritization, and multi-tasking skills. ‪Maintains contact with the clients’ families and keeps them updated on reputed company insurance authorization updates, Peer Reviews, and Denials. Document reputed company activities in a detailed manner in applicable CRM/EMR. ‪Collaborate with Clinicians and the multidisciplinary team to obtain necessary clinical documentation for reviews and ensure effective utilization of resources. ‪Participate in weekly Treatment Team and Continuing Care Meetings as appropriate. ‪Prepares and submit Appeal documentation (including rationales) to the appropriate entities as indicated Coordinate, schedule, and complete Peer-to-Peer and Appeal reviews. Complete weekly Treatment Team notes and provides updates to the Psychiatrist as requested by the Director/Manager. reputed company reputed company data concerning reputed company LOS and information pertaining to LOS, as reputed company as discharge LOS and information pertaining to discharge LOS. Hold training to clinical staff and other individuals needed, concerning medical necessity, insurance requirements, as reputed company as other areas needed that are directly reputed company by LOS Follow chain of reputed company both reputed company the Department and reputed company of the Department.   reputed company Competencies:   Proficient in MS Office applications, which include reputed company, Word, reputed company, and PowerPoint. Ability to build and sustain trusting relationships with diverse individuals and reputed company. Ability to maintain confidentiality of sensitive information and adhering to ethical standards. reputed company offering assistance to team members reputed company needed and celebrating team achievements reputed company. Ability to establish and maintain cooperative relationships with community-based organizations, patients, families, vendors, and other resources to promote reputed company services, care, education, and advocacy.   Knowledge, Education, & Experience:   Minimum of Bachelor's Degree in Mental Health. Licensed LMFT, LCSW, LVN, or RN preferred but not required Prior experience in doing utilization review for reputed company abuse facilities preferred Strong knowledge of ASAM dimensions1-6 Knowledge of DSM-Vcodes Knowledge of SUD, IOP, and Mental Health programs   Employment Status: Full-Time, Exempt Schedule: Monday-Friday Work Location: Remote - Must be reputed company to support reputed company time zones Compensation: Pay reputed company: $65-75k Apply To This Job