Case Management & Utilization Specialist I

Sun Behavioral Health Group; Erlanger (KY); On-site; USD 60,000 - 85,000; Full time

Job summary

Sun Behavioral Health Group in Erlanger, KY seeks a dedicated RN Case Manager to coordinate patient care from pre-hospitalization to discharge. You will assist with admissions authorizations and manage retroactive reviews and appeals with insurers.

You will document patient status in the EMR, communicate with physicians, nurses, and payors, and participate in performance improvement activities. Regular staff meetings are required.

Qualifications

• High school diploma or GED with CPR and de-escalation certification.
• One year of experience in behavioral healthcare.
• Preferred: associate or bachelor’s degree.
• Ability to coordinate with payors and manage reviews.

Responsibilities

• Coordinate care for patient from pre-hospitalization through discharge.
• Assist with authorization of admissions.
• Process retroactive reviews and appeals with insurers.
• Document in EMR and communicate with physicians, nurses, and payors.
• Attend staff meetings and participate in quality improvement activities.

Skills

Case management coordination

Documentation and logging

Communication with payors

EMR documentation

Quality improvement

Team collaboration

Education

High school diploma or GED

CPR certification

De-escalation technique certification

Associate or Bachelor’s degree

Tools

EMR system

Job description

Sun Behavioral Health Group in Erlanger, KY seeks a dedicated RN Case Manager to coordinate patient care from pre-hospitalization to discharge. You will assist with admissions authorizations and manage retroactive reviews and appeals with insurers.

You will document patient status in the EMR, communicate with physicians, nurses, and payors, and participate in performance improvement activities. Regular staff meetings are required.