Behavioral Health Utilization & Case Manager

Luminis Health; Annapolis (MD); On-site; USD 82,000 - 123,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Retirement Plan with employer match

Paid Time Off

Tuition Assistance Benefits

Employee Referral Bonus Program

Paid Holidays, Disability, and Life/AD

Wellness Programs

Employee Assistance Programs

Benefit offerings based on employment

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Job summary

Luminis Health is seeking a Utilization Review/Case Manager for the Lanham Partial Hospitalization program. The role focuses on concurrent utilization review, case referrals, and ensuring appropriate patient placement. Collaboration with medical staff and payors supports medical necessity determinations.

The position requires a BA/BS and a minimum of two years in utilization review or utilization management, with duties spanning data tracking and appeals within a behavioral health setting.

Qualifications

• BA/BS required for the role.
• Minimum two years of experience in utilization review or utilization management.

Responsibilities

• Perform and monitor integrated utilization review and case referrals.
• Collaborate with medical staff to obtain clinical documentation for review.
• Verify medical necessity and pre-authorizations; monitor continued stay.
• Prepare monthly statistics and report to Clinical Director.
• Relate findings to the multidisciplinary treatment team and appeals.

Skills

Utilization review

Case management

Clinical documentation

Interdisciplinary collaboration

Education

BA/BS

Job description

Luminis Health is seeking a Utilization Review/Case Manager for the Lanham Partial Hospitalization program. The role focuses on concurrent utilization review, case referrals, and ensuring appropriate patient placement. Collaboration with medical staff and payors supports medical necessity determinations.

The position requires a BA/BS and a minimum of two years in utilization review or utilization management, with duties spanning data tracking and appeals within a behavioral health setting.