Behavioral Health Utilization Review & Case Manager

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

Job summary

Luminis Health in Lanham, MD is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program to perform integrated utilization reviews and coordinate patient placement. You will collaborate with medical staff to obtain and review clinical documentation, pre-authorize patients when needed, and monitor continued stay for medical necessity across diverse clinical areas.

This exempt, full-time role offers strong benefits and a collaborative clinical team in a dynamic behavioral

Qualifications

• BA/BS degree required.
• Two years of experience performing utilization review or utilization management.

Responsibilities

• Performs and monitors integrated, concurrent utilization review and case referrals on patients, consistent with approved Utilization Review Plans.
• Works with medical staff to obtain clinical documentation for review and optimal patient placement.
• Maintains contact with Managed Care and third party payors to assure appropriate case management.
• Assesses data reflective of the patient status and interprets information for age-specific needs.
• Determines medical necessity and appropriateness of admission using established criteria.
• Verifies pre-admission assessment is performed and pre-authorizes patients as applicable.

Education

BA/BS

Job description

Luminis Health in Lanham, MD is seeking a Utilization Review/Case Manager for the Partial Hospitalization Program to perform integrated utilization reviews and coordinate patient placement. You will collaborate with medical staff to obtain and review clinical documentation, pre-authorize patients when needed, and monitor continued stay for medical necessity across diverse clinical areas.

This exempt, full-time role offers strong benefits and a collaborative clinical team in a dynamic behavioral