Payor-Ready Clinical Utilization Case Manager

James Barry-Robinson Institute; Norfolk (VA); On-site; USD 55,000 - 60,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

403(b) retirement plan with company</s

Company paid life and long-term-dis

Paid vacation and sick leave

8 paid holidays

Tuition reimbursement

Public Service Loan Forgiveness (PSLF)

Employee assistance program

Performance reviews

Career advancement opportunities

Job summary

Barry Robinson Center in Norfolk, VA seeks a Clinical Utilization Case Manager to act as the clinical link between the treatment team, the Center, and external payors. You will justify residential treatment, ensure accurate documentation, and maintain case files in line with regulatory and payor requirements.

The ideal candidate is organized, independent, and capable of producing payor-ready reports while supporting military-connected youth and families. Office hours are Monday–Friday, 8:30 a.m.

Qualifications

• Minimum 1 year of clinical experience in an inpatient mental health setting.
• Ability to manage a caseload of at least 30 clients and meet deadlines.
• Strong writing, proofreading, organizational, and time management skills.
• Ability to apply payor criteria to clinical information and write narrative reports.
• Quantitative skills to prepare statistical data and reports.
• Sensitivity to report content and liability issues.
• Proficiency in Microsoft Office and familiarity with EMRs and payor portals.
• Preferred: LPN/RN licensure; BA/BS in Human Services; payor experience.

Responsibilities

• Communicate with payors and case management companies submitting documentation to justify care by deadlines.
• Conduct utilization review of records to support medical necessity for continued RTC care.
• Monitor service delivery for payor criteria and report issues potentially affecting authorization.
• Verify treatment plans and staffing reports include payor-required elements.
• Review treatment plan progress and report to payors.
• Collaborate with treatment team monthly to update reviews and goals.
• Collect and assess data for quality improvement and report issues to HIM and departments.
• Partner with departments and outside providers to ensure complete documentation and discharge planning.
• Complete payor-required discharge summary within required timeframes.

Skills

Clinical experience

Caseload management

Writing & proofreading

Payor criteria interpretation

Statistical data

Microsoft Office

EMRs familiarity

Payor portals

Education

LPN/RN licensure

BA/BS in Human Services

Tools

Microsoft Office (Outlook, PowerPoint, Excel)

EMRs

Payor portals

Job description

Barry Robinson Center in Norfolk, VA seeks a Clinical Utilization Case Manager to act as the clinical link between the treatment team, the Center, and external payors. You will justify residential treatment, ensure accurate documentation, and maintain case files in line with regulatory and payor requirements.

The ideal candidate is organized, independent, and capable of producing payor-ready reports while supporting military-connected youth and families. Office hours are Monday–Friday, 8:30 a.m.