DescriptionMust have previous experience in behavioral health, preferred drug and alcohol. Attention to details, and a drive to help individuals in their journey. Team player with knowledge around ASAM. Monday through Friday with one Saturday per month. ESSENTIAL FUNCTIONS:UR
Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
Case Manager
Provide case management and care coordination services for clients/patients/residents in the facility.
Responsible for coordinating continuum of care activities for assigned clients and ensuring optimum utilization of resources, service delivery, and compliance with external agencies and referral sources requirements.
Responsible for psychosocial assessment and for conducting individual, family and group sessions.
Conduct various duties related to coordinating treatment and discharge activities, as needed.
Provide quality care through developing, implementing, managing and evaluating client/patient care plans.
Collect, correlate and provide clinical data to the treatment team.
Convey medical criteria and clinical information between the insurance provider and treatment team as warranted.
May also correlate clinical data for business office as required.
Coordinate in a timely manner, issues or activities relevant to the treatment team.
Benefits:¨ Medical/Dental/Vision insurance¨ Flexible Spending Accounts and Healthcare Savings Accounts¨ Company paid basic life insurance and AD&D¨ Supplemental life insurance and AD&D¨ 401K (with match)THE ABILITY TO SAVE SOMEONES LIFE!QualificationsSkillsPreferred
Problem Solving: Novice
Attention to Detail: Novice
Communication: Novice
BehaviorsPreferred
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Team Player: Works well as a member of a group
MotivationsPreferred
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
Self-Starter: Inspired to perform without outside help
Flexibility: Inspired to perform well when granted the ability to set your own schedule and goals
EducationRequired
Bachelors or better in Social Work
Licenses & CertificationsPreferred
Reg Nurse
Lic Practical Nurse
ExperiencePreferred
2 years: Experience with the population of the facility and previous experience in utilization management
Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
