CASE MANAGER (BSW)

Universal Health Services, Inc.; Guaynabo (PR); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Competitive compensation

Medical/Dental/Vision plans

401(k) with company match

Career development

Job summary

Universal Health Services, Inc. in Puerto Rico is seeking a Case Manager to support the Behavioral Health Contact Center, handling calls 24/7, assessing needs, coordinating referrals to appropriate care levels, and documenting services.

You will educate members on coverage benefits, maintain confidentiality under HIPAA, and collaborate with clinicians to ensure timely access to services and crisis response. Experience in crisis intervention and knowledge of health plan benefits are preferred.

Qualifications

• Bachelor’s in social work or psychology (required).
• 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, identifying oneself by name, title, and organization.
• Provide support to members by conducting needs assessments, brief interventions, and referrals.
• Coordinate with licensed clinicians for emergency calls and urgent cases.
• Educate members on program offerings and benefit coverage while ensuring confidentiality.
• Document call information and review service requests for completeness.
• Ensure compliance with HIPAA and internal policies.

Skills

Customer service

Excellent interpersonal skills

Fully bilingual (preferred)

Rotating shifts

Education

Bachelor’s in social work or psychology

Tools

Microsoft Office

Job description

Responsibilities

FHCHS of PR, Inc. organization with extensive experience in managing mental health benefits and developing solutions that promote the emotional well-being of individuals, families, workplaces, and communities. Since our foundation in 1996, at FHC Mental Health, we have worked to facilitate access to excellent mental health services and support people at different stages of their lives. Our experience has allowed us to evolve, expand our services, and develop integrated solutions that promote prevention, guidance, recovery, and continuity of care.

Website: https://fhcsaludmental.com/

The Case Manager supports the Behavioral Health Contact Center team in responding to individuals in need of services, orientation and/or crisis during the seven days of the week, 24 hours. 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. The Case Manager uses clinical structured data to determine based on eligibility criteria the appropriate services according to members' needs and benefits under the health plan. The goal of the services provided is to support members' wellness. The Case Manager is responsible for documenting the services authorization and complying with the established processes to coordinate services with the providers. Case Manager educates and orients members, their representatives and their dependents about the coverage benefits and community resources available.

The case manager is responsible for providing support in the coordination and notification of appointments scheduled for our members, in accordance with the timeframes established in the organization's policies. This role also ensures the accessibility and care of the members.

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

Benefit& RewardsHighlights:

• 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.

About Universal Health Services

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune500 corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World's Most Admired Companies and in 2025, was listed in Forbes ranking of America's Largest Public Companies.

Headquarters in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com.

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 as such, 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.