CASE MANAGER (BSW)

Universal Health Services; Guaynabo (PR); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Competitive compensation

Career development opportunities

401(k) with company match

Tuition incentive

Continuing education incentive

Paid time off

Job summary

Universal Health Services seeks a Case Manager to support the Behavioral Health Contact Center in Puerto Rico. The role involves responding to individuals in need of services, conducting needs assessments, coordinating referrals, and ensuring access to appropriate levels of care.

Responsibilities include handling emergency situations with licensed clinicians, documenting interactions, maintaining confidentiality, and meeting quality metrics.

Qualifications

• Bachelor’s in social work or psychology.
• Knowledge in Microsoft Office.
• Preferred fully bilingual.
• Customer service experience.
• Excellent interpersonal skills.
• Must be available to work rotating shifts.

Responsibilities

• Answer incoming calls within established timeframes per BHCC standards.
• Provide support via needs assessments, brief interventions, referrals.
• Manage emergency calls with licensed clinicians and coordinate with emergency services.
• Consult with supervisors and escalate cases outside scope.
• Direct members to levels of care and coordinate with emergency services.
• Follow reporting procedures for abuse/neglect and suicidal/homicidal risk.
• Verify eligibility and educate on program offerings and benefits.
• Conduct structured data collection using approved scripts and BT triage platform.
• Maintain confidentiality and document services per HIPAA and policies.
• Perform outbound calls, send materials, and complete follow-ups.
• Meet quality metrics: abandon rate, ASA, routing, first call resolution.
• Interact with providers and care team to ensure continuity of services.
• Validate admissions and document in Web Census; provide after-hours UR backup.
• Participate in training and uphold Code of Conduct and Ethics.

Skills

Bachelor’s degree in social work or PS

Microsoft Office

Bilingual (preferred)

Customer service

Interpersonal skills

Rotating shifts availability

Education

Bachelor’s degree in social work or psychology

Tools

Microsoft Office

Job description

Responsibilities

FHCHS of PR, Inc. is an organization with extensive experience in managing mental health benefits and developing solutions that promote emotional well‑being. Since 1996, FHC Mental Health has facilitated access to excellent mental health services, supporting people at different life stages through integrated solutions focused on prevention, guidance, recovery, and continuity of care.

The Case Manager supports the Behavioral Health Contact Center team in responding to individuals in need of services, orientation, or crisis 24/7. Case Managers provide case‑management services and refer members to the appropriate level of care after consulting with the Clinical Manager, Clinical Supervisor, Director, VP of Clinical, or Psychiatrist. They use clinical structured data to determine appropriate services based on eligibility criteria, member needs, and health‑plan benefits. The goal is to support member wellness. The Case Manager documents service authorizations, coordinates with providers, and educates members, representatives, and dependents about coverage benefits and community resources.

The case manager also coordinates and notifies members about scheduled appointments in accordance with organizational policies, ensuring accessibility and quality of care. Website: https://fhcsaludmental.com/.

Job Duties / Responsibilities

1. Answer incoming calls within established timeframes, identifying oneself by name, title, and organization as required by Behavioral Health Contact Center (BHCC) standards, while maintaining clear, professional communication and active listening.
2. Provide support to members by conducting needs assessments, brief interventions, supportive engagement, and facilitating appropriate referrals based on presenting concerns.
3. Manages the emergency calls in coordination with a licensed clinician, coordinates with emergency services (911), and facilitates immediate access to help.
4. Maintains immediate access to clinical supervisors, psychiatrists, or licensed clinicians, consulting and escalating cases that fall outside their scope of practice.
5. Direct members to appropriate levels of care, including outpatient services, inpatient treatment, and community-based resources; collaborate with emergency response services when urgent intervention is required.
6. Follow internal mandatory reporting procedures for cases involving abuse, neglect, or risk to self or others, and ensure immediate access to emergency services when individuals present suicidal or homicidal ideation or threats.
7. Verify member eligibility, accurately document call information in organizational platforms, and educate members or authorized representatives on program offerings and benefit coverage.
8. Conduct structured clinical data collection using approved scripts, perform telephone interviews using the Triage Logic platform, gather clinical and non‑clinical information, perform tasks that do not require clinical interpretation, and review service requests for completeness.
9. Maintain confidentiality of all documents and information received and document services in compliance with HIPAA, Law 408, and internal policies.
10. Perform outbound calls, send or fax materials, complete TTY validations, conduct referral follow‑ups, and complete callback tasks as assigned.
11. Comply with established quality parameters, including abandonment rate, average speed of answer (ASA), service coordination and notification, call classification and routing, and first call resolution.
12. Interact with providers, members, and care team professionals to ensure continuity of services; manage emergency calls in coordination with licensed clinicians following BHCC procedures.
13. Validate admission registration processes for mental health services, input inpatient admission data when facilities are unable to do so, confirm admissions and discharges with psychiatric facilities, and enter related information in the Web Census platform.
14. Provide UR backup after business hours, including documenting service requests, offering status updates, explaining operational information, processing authorized services, and sending provider notifications.
15. Participate in assigned projects and mandatory training (Compliance, HR, departmental, URAC, NCQA, CMS), and consistently apply all BHCC‑related policies, procedures, Code of Conduct, Ethics, Confidentiality, and Service Excellence standards.
16. Support the onboarding of new Case Managers, inform supervisors of issues affecting workflow, and participate in professional development and mental health–related training.
17. Performs other duties as assigned/required by this position.

Qualifications

• Bachelor’s in social work or psychology
• Knowledge in Microsoft Office
• Preferred fully bilingual
• Customer service
• Excellent interpersonal skills
• Must be available to work rotating shifts

Benefits & Rewards Highlights

• Competitive Compensation
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match
• Career development opportunities within UHS and its 300+ Subsidiaries!
• Tuition incentive
• Continuing education incentive
• Vacation and sick license, among others.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal‑opportunity employers and openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.