On-Site Utilization Review Case Manager

Dallas-Behavioral-Healthcare-Hospital; DeSoto (TX); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Job summary

Dallas-Behavioral-Healthcare-Hospital is seeking a dedicated Utilization Review Case Manager to collaborate with insurance providers for admissions authorization, concurrent reviews, and retrospective assessments.

The role requires a clinical degree with RN or LVN preferred, at least two years of relevant experience, on-site work, and strong knowledge of managed care, medical terminology, and documentation practices to ensure timely access to benefits for patients.

Qualifications

• Clinical degree preferred (RN/LVN) or related healthcare field.
• Two years of clinical experience with medical terminology and acute psychiatric care criteria preferred.
• Ability to apply and interpret admission and continued stay criteria.
• Familiarity with medical records, standards and regulations.
• Strong written and verbal communication skills for care coordination.
• Background check, drug screen and references required.

Responsibilities

• Conduct admission reviews.
• Conduct concurrent and extended stay reviews.
• Prepares and submits appeals to third party payors.
• Maintains appropriate records of the Utilization Review Department.
• Performs related duties as requested.
• Upholds the Organization's ethics and customer service standards.

Skills

Time management

Multi-tasking

Attention to detail

Communication skills

Knowledge of managed care

Medical terminology

Interpersonal skills

Policy interpretation

Education

Clinical degree (RN or LVN preferred)

Tools

EMR systems

Job description

Dallas-Behavioral-Healthcare-Hospital is seeking a dedicated Utilization Review Case Manager to collaborate with insurance providers for admissions authorization, concurrent reviews, and retrospective assessments.

The role requires a clinical degree with RN or LVN preferred, at least two years of relevant experience, on-site work, and strong knowledge of managed care, medical terminology, and documentation practices to ensure timely access to benefits for patients.