Case Manager UR

Ventura Services Florida; Zachary (LA); On-site; USD 52,000 - 72,000; Full time

Job summary

Seaside Health System is seeking a Utilization Review (Case Manager) to organize and provide information for pre-certifications and authorizations from insurers. This non-exempt role reports to Clinical Supervisors and is based in a clinical office setting.

Responsibilities include direct patient care support, UR functions, coordinating with the treatment team, and documenting caseload psychoeducation groups. Must have a Bachelor's degree and CPR/CPI certification.

Qualifications

• Must have Bachelor’s degree in related field.
• Must maintain CPR and CPI certification.
• Experience with Utilization Review in behavioral health and government assistance preferred.
• Good verbal and written communication skills.
• Computer literate.
• Completes assignments accurately, in a timely manner, and within procedural guidelines.

Responsibilities

• Provides direct patient care by assisting patients with all aspects of case management needs.
• Assists patient and treatment team in UR functions – Obtaining pre-certifications and authorizations from insurance companies to ensure treatment coverage and payment.
• Participates as an active member of treatment team.
• Facilitates psychoeducation groups and document on assigned caseload.
• Other duties as assigned/required.

Skills

Verbal and written communication

Computer literacy

Time management

Education

Bachelor’s degree in related field

CPR certification

CPI certification

Job description

Job Title: Utilization Review (Case Manager)

FLSA Status: Non-exempt

Program: Progressive PHP of Seaside Health System

Reports To: Clinical Supervisor/Assistant Clinical Supervisor

Position Summary:

The Utilization Review (Case Manager) is responsible for organizing and providing quality information required

to advocate for pre-certifications and authorizations from insurance companies for our patients.

Required Knowledge, Skills, Licensure, Training & Travel Requirements (if applicable):

Education:

Must have Bachelor’s degree in related field. Must maintain certification in CPR and CPI.

Work experience:

Experience with Utilization Review in behavioral health and government assistance preferred.

Knowledge, Skills & Abilities:

Must possess good verbal and written communication skills. Should be computer literate. Completes assignments accurately, in a timely manner, and within procedural guidelines. Organizes and prioritizes work.

Interpersonal Skills:

Possess excellent interpersonal skills to help facilitate the development of rapport with patients and their family members, referral sources; and to work cooperatively with in-house physicians, and administrative, clinical and support staff members. Displays self-direction by seeking solutions to problems. Seeks out and offers new ideas for improving processes. Deals constructively in stress.

General Performance:

Must display willingness to help others. Uses appropriate customer etiquette, e.g., telephone, conversation, demeanor, etc. Takes direction well, accepts constructive criticism and responds accordingly. Respects customer’s, co-worker’s, and organization’s confidentiality. Follow policies/procedures such as appearance, dress, safety, appropriate patient/staff interactions, etc. Works positively with both internal and external customers. Is punctual in all aspects of work. Adheres to attendance policy.

Travel Requirements:

None.

Essential Job Duties & % of Time

1. Provides direct patient care by assisting patients with all aspects of case management needs (i.e., helping patients find the best resources needed.) - 25%


2. Assists patient and treatment team in UR functions · Obtaining pre-certifications and authorizations from insurance companies to ensure treatment coverage and payment- 25%


3. Participates as an active member of treatment team - 15%


4. Facilitates psychoeducation groups and document on assigned caseload -30%


5. Other duties as assigned/required - 5%

Guidance Requirement: Indicate the degree to which the position is guided by the Supervisor/Manager

Procedures well established. Few decisions made. Supervisor readily available as needed.

Physical Effort Requirement:

Physical Effort found in normal office environment.